Provider Demographics
NPI:1992912893
Name:LUGO RIVERA, AMNERIS (MD)
Entity type:Individual
Prefix:
First Name:AMNERIS
Middle Name:
Last Name:LUGO RIVERA
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:PO BOX 195095
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5095
Mailing Address - Country:US
Mailing Address - Phone:787-765-8620
Mailing Address - Fax:787-767-6138
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:COND TORRE AUXILIO MUTUO OF 704
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5029
Practice Address - Country:US
Practice Address - Phone:787-765-8620
Practice Address - Fax:787-767-6138
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5780207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27134Medicare UPIN