Provider Demographics
NPI:1346266301
Name:ROSARIO LUGO, LOURDES REBECCA (MD)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:REBECCA
Last Name:ROSARIO LUGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 RETREAT DR APT 103
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7895
Mailing Address - Country:US
Mailing Address - Phone:656-217-0802
Mailing Address - Fax:
Practice Address - Street 1:3195 RETREAT DR APT 103
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7895
Practice Address - Country:US
Practice Address - Phone:656-217-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1104208D00000X
PR11298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89013Medicare ID - Type Unspecified
49990GMedicare UPIN