Healthcare Provider Details

I. General information

NPI: 1972806537
Provider Name (Legal Business Name): SERVICIOS MEDICOS ILUMINA-TUS, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2069 CALLE BUENOS AIRES
SAN JUAN PR
00911-1756
US

IV. Provider business mailing address

352 CALLE DEL PARQUE
SAN JUAN PR
00912-3702
US

V. Phone/Fax

Practice location:
  • Phone: 787-723-5574
  • Fax: 787-721-4035
Mailing address:
  • Phone: 787-723-5574
  • Fax: 787-721-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. VICTOR A COLON-SANCHEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-604-4589