Healthcare Provider Details

I. General information

NPI: 1437539541
Provider Name (Legal Business Name): LILIANA COLON SANTOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LILIANA COLON SANTOS M.D.

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TECHNOLOGY PARK STE 109
LAKE MARY FL
32746-7107
US

IV. Provider business mailing address

1 RIO CANAS R 798 K2
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-619-0413
  • Fax:
Mailing address:
  • Phone: 787-619-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number19502
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME156377
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19502
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: