Provider Demographics
NPI:1871051128
Name:RUIZ LUGO, CARLOS EDUARDO ANTONIO SR (ENFERMERO RN, WCS)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:EDUARDO ANTONIO
Last Name:RUIZ LUGO
Suffix:SR
Gender:M
Credentials:ENFERMERO RN, WCS
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Mailing Address - Street 1:80 CABO ROJO
Mailing Address - Street 2:URB MANSIONES DE CABO ROJO PALMAS
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-398-2164
Mailing Address - Fax:787-255-1846
Practice Address - Street 1:80 CABO ROJO
Practice Address - Street 2:URB MANSIONES DE CABO ROJO PALMAS
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-8933
Practice Address - Country:US
Practice Address - Phone:787-398-2164
Practice Address - Fax:787-255-1846
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-06-11
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Provider Licenses
StateLicense IDTaxonomies
PR075971163WC0200X, 163WE0003X, 163WG0000X
PR078971163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR075971Medicaid