Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14114 | PR |
NPI | 1013102508 |
---|---|
Provider Name | Carlos M Gonzalez-Lugo |
First Address | San Juan, PR 00901-1710 |
Second Address | San Juan, PR 00901-1710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2007 |
Last Update Date | 08/09/2007 |