Provider Demographics
NPI:1316919111
Name:FREYTES-LUGO, LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:FREYTES-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 1329
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1329
Mailing Address - Country:US
Mailing Address - Phone:787-264-0110
Mailing Address - Fax:787-264-0110
Practice Address - Street 1:87 AVE UNIV INTERAMERICANA
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4338
Practice Address - Country:US
Practice Address - Phone:787-264-0110
Practice Address - Fax:787-264-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF20413Medicare UPIN
PR0082822Medicare ID - Type Unspecified