Provider Demographics
NPI:1467603027
Name:DE LA TORRE - LUGO, ENEIDA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:ENEIDA
Middle Name:MARIA
Last Name:DE LA TORRE - LUGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. RIVIERA VILLAGE
Mailing Address - Street 2:29 CALLE GRAMERCY
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-2709
Mailing Address - Country:US
Mailing Address - Phone:787-630-1471
Mailing Address - Fax:
Practice Address - Street 1:73 CALLE SANTA CRUZ
Practice Address - Street 2:STE 103
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6934
Practice Address - Country:US
Practice Address - Phone:787-622-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17986207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology