Provider Demographics
NPI:1053385005
Name:GUZMAN-LUGO, LUIS A (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:GUZMAN-LUGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1616
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1616
Mailing Address - Country:US
Mailing Address - Phone:787-740-2608
Mailing Address - Fax:787-740-2612
Practice Address - Street 1:SANTA JUANITA AVENUE
Practice Address - Street 2:WP3
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-740-2608
Practice Address - Fax:787-740-2612
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13865207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRGR209AOtherMEDICARE ID
PRGR209AMedicare PIN
PRH67163Medicare UPIN