Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 7214 | PR |
NPI | 1285602987 |
---|---|
Provider Name | Dr. Humberto Lugo Vicente |
First Address | San Juan, PR 00922-0426 |
Second Address | Bayamon, PR 00961-6910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 08/07/2007 |