Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 14272 | PR |
Y | 208D00000X | General Practice Physician | ACN452 | FL |
NPI | 1013951797 |
---|---|
Provider Name | Dr. Carlos Javier Lugo |
First Address | Champions Gate, FL 33896-8387 |
Second Address | Kissimmee, FL 34743-8626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 04/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006614400 | (05) | FL |
ACN452 | MEDICINE DOCTOR LIC (01) | FL |