Provider Demographics
NPI:1982355293
Name:MENDEZ LUGO, ANGEL FRANCISCO
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:FRANCISCO
Last Name:MENDEZ LUGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 RANGE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2105
Mailing Address - Country:US
Mailing Address - Phone:939-389-7619
Mailing Address - Fax:
Practice Address - Street 1:1215 RANGE VIEW CIR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2105
Practice Address - Country:US
Practice Address - Phone:939-389-7619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant