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Organization
INFECTIOUS DISEASE SPECIALIST OF SOUTHERN COLORADO, PLLC
Active
Organization
INFECTIOUS DISEASE SPECIALIST OF SOUTHERN COLORADO, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR NWANGUMA M.D (CEO)
(719) 582-8425
Entity
Organization
Contact information
Practice address
2001 LAKE AVE, SUITE 2, PUEBLO, CO 81004-3538
(719) 582-8425
(888) 719-1380
Mailing address
PO BOX 470238, AURORA, CO 80047-0238
(719) 582-8425
(888) 719-1380
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
DR51262
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336601387
NPI
—
Enumeration date
10/24/2012
Last updated
01/29/2023
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