Provider Demographics
NPI:1699884262
Name:LUGO, RAFAEL EDUARDO (DC)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:EDUARDO
Last Name:LUGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CALLE 1
Mailing Address - Street 2:URB. LA CAMPINA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9636
Mailing Address - Country:US
Mailing Address - Phone:787-738-8333
Mailing Address - Fax:787-263-7522
Practice Address - Street 1:10 CALLE JOSE CELSO BARBOSA N
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3730
Practice Address - Country:US
Practice Address - Phone:787-738-8333
Practice Address - Fax:787-263-7522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0062118Medicare ID - Type Unspecified
PR90643Medicare UPIN