Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 007643 | PR |
NPI | 1043270028 |
---|---|
Provider Name | Dr. Octavio A. Ramirez Lugo |
First Address | Carolina, PR 00988 |
Second Address | San Juan, PR 00924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 28/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C77759 | (02) | PR |