Healthcare Provider Details

I. General information

NPI: 1548781388
Provider Name (Legal Business Name): LS PHYSIATRY AND SPORTS MEDICINE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2017
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 AVE ANDALUCIA
SAN JUAN PR
00920-5311
US

IV. Provider business mailing address

400 GRAND BLVD LOS PRADOS APT 30103
CAGUAS PR
00727-3383
US

V. Phone/Fax

Practice location:
  • Phone: 787-957-5553
  • Fax:
Mailing address:
  • Phone: 787-501-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number19393
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number19393
License Number StatePR

VIII. Authorized Official

Name: LUIS ALBERTO SANCHEZ COLON
Title or Position: PRESIDENT
Credential: MD
Phone: 787-501-3399