MEDICARE: SERVICIOS MEDICOS ILUMINA-TUS, CSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	171100000X	Acupuncturist
2	171M00000X	Case Manager/Care Coordinator
3	302F00000X	Exclusive Provider Organization
4	261QH0100X	Health Service Clinic/Center	PR

General Provider Information

NPI Number	:	1972806537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVICIOS MEDICOS ILUMINA-TUS, CSP

Provider Business Mailing Address
First Line	:	352 CALLE DEL PARQUE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3702
Country	:	US
Telephone Number	:	787-723-5574
Fax Number	:	787-721-4035

Provider Business Practice Location Address
First Line	:	2069 CALLE BUENOS AIRES
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00911-1756
Country	:	US
Telephone Number	:	787-723-5574
Fax Number	:	787-721-4035

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICTOR A COLON-SANCHEZ
Credential	:	M.D.
Telephone Number	:	787-604-4589

Provider Enumeration Date	:	12/20/2010
Last Update Date	:	12/20/2010

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