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General NPI Number Information
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NPI Number | 1528364064
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Entity Type | Organization
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Legal Business Name | LIRIO S. POLINTAN MD PC
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 1600 N GRAND AVE STE 345
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City | PUEBLO
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State | CO
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Zip | 81003-2762
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Country | US
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Telephone | 171-954-5055
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Fax | 719-545-2945
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Provider Business Mailing Address
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Address Line | 1600 N GRAND AVE STE 345
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City | PUEBLO
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State | CO
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Zip | 81003-2762
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Country | US
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Telephone | 171-954-5055
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Fax | 719-545-2945
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIRIO S POLINTAN
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Credential | M.D.
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Telephone | 719-545-0552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 24270
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License Number State | CO
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