Provider Demographics
NPI:1053977678
Name:RIOS LUGO, REBECA (SOCIAL WORKER)
Entity type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:
Last Name:RIOS LUGO
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 55 BOX 8381
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-9732
Mailing Address - Country:US
Mailing Address - Phone:939-249-6323
Mailing Address - Fax:
Practice Address - Street 1:108 CALLE LOS PINOS
Practice Address - Street 2:PARCELAS AGUAS CLARAS
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735
Practice Address - Country:US
Practice Address - Phone:939-249-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11738104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11738OtherHEALTH PLANS