Provider Demographics
NPI:1356380869
Name:SAN MIGUEL, LUCIA (MD)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:SAN MIGUEL
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 1:556 AVE GONZALEZ CLEMENTE
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1138
Mailing Address - Country:US
Mailing Address - Phone:787-951-7077
Mailing Address - Fax:
Practice Address - Street 1:566 AVE GONZALEZ CLEMENTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-951-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR95952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry