Provider Demographics
NPI:1114127404
Name:LUGO, MIRIAN DOLORES (MD)
Entity type:Individual
Prefix:
First Name:MIRIAN
Middle Name:DOLORES
Last Name:LUGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3319 S STATE ROAD 7 STE 109
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8099
Mailing Address - Country:US
Mailing Address - Phone:561-798-5437
Mailing Address - Fax:561-798-7726
Practice Address - Street 1:3319 S STATE ROAD 7 STE 109
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8099
Practice Address - Country:US
Practice Address - Phone:561-798-5437
Practice Address - Fax:561-798-7726
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2025-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148908208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics