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General NPI Number Information
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NPI Number | 1972806537
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Entity Type | Organization
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Legal Business Name | SERVICIOS MEDICOS ILUMINA-TUS, CSP
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 2069 CALLE BUENOS AIRES
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City | SAN JUAN
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State | PR
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Zip | 00911-1756
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Country | US
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Telephone | 787-723-5574
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Fax | 787-721-4035
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Provider Business Mailing Address
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Address Line | 352 CALLE DEL PARQUE
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City | SAN JUAN
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State | PR
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Zip | 00912-3702
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Country | US
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Telephone | 787-723-5574
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Fax | 787-721-4035
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR A COLON-SANCHEZ
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Credential | M.D.
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Telephone | 787-604-4589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | PR
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