# INFECTIOUS DISEASE SPECIALIST OF SOUTHERN COLORADO, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922351279
- **Authorized official:** DR. VICTOR NWANGUMA M.D (CEO)
- **Authorized official phone:** (719) 582-8425

## Contact information

- **Practice address:** 2001 LAKE AVE, SUITE 2, PUEBLO, CO 81004-3538
- **Practice address phone:** (719) 582-8425
- **Practice address fax:** (888) 719-1380
- **Mailing address:** PO BOX 470238, AURORA, CO 80047-0238
- **Mailing address phone:** (719) 582-8425
- **Mailing address fax:** (888) 719-1380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | DR51262 | CO | Yes |

## Other

- **Enumeration date:** 10/24/2012
- **Last updated:** 01/29/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1336601387 | NPI | — |