Healthcare Provider Details

I. General information

NPI: 1497133037
Provider Name (Legal Business Name): LS ID SPECIALTY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA JUAN MARTINEZ 14 CONDOMINIO MALAGA PARK NUMBER 77
GUAYNABO PR
00971
US

IV. Provider business mailing address

AVENIDA JUAN MARTINEZ 14 CONDOMINIO MALAGA PARK NUMBER 77
GUAYNABO PR
00971
US

V. Phone/Fax

Practice location:
  • Phone: 787-613-5742
  • Fax:
Mailing address:
  • Phone: 787-613-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier338275
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerREGISTRY

VIII. Authorized Official

Name: LILIA R SANCHEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-613-5742