Doctor Name: | LUIS M SIACA COLON |
NPI Number: | 1972587707 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 012479 |
Business Practice Address: | Diaz Bretana Medical Building Oficina 202 San Lorenzo, PR - 00754 |
Business Phone Number: | 7877368265 |
Business Fax Number: | 7877368265 |
Mailing Address: | Chalets De Bairoa C/colibri #96, CAGUAS |
State: | PR |
Postal Code: | 007271272 |
Phone Number: | 7873083602 |
Fax Number: | 7877368265 |
NPI Enumeration Date: | 12/05/2005 |
NPI Last Update Date: | 09/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 012479 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |