Provider Demographics
NPI:1982451183
Name:LUGO, BRUNILDA ENID
Entity type:Individual
Prefix:
First Name:BRUNILDA
Middle Name:ENID
Last Name:LUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10637 BASTILLE LN APT 207
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-4650
Mailing Address - Country:US
Mailing Address - Phone:689-345-4004
Mailing Address - Fax:
Practice Address - Street 1:10637 BASTILLE LN APT 207
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-4650
Practice Address - Country:US
Practice Address - Phone:689-345-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician