Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 13865 | PR |
NPI | 1053385005 |
---|---|
Provider Name | Dr. Luis A. Guzman-Lugo |
First Address | Bayamon, PR 00960-1616 |
Second Address | Bayamon, PR 00956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 25/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GR209A | MEDICARE ID (01) | PR |
H67163 | (02) | PR |