Organization
ILUMINA LIFE CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FLORENTINA MAYKO (CEO)
(814) 467-4055
Entity
Organization
Contact information
Practice address
507 TIRE HILL RD, SUITE 100, JOHNSTOWN, PA 15905-7311
(814) 467-4055
(814) 262-9816
Mailing address
136 JAYCEE DR, SUITE 10, JOHNSTOWN, PA 15904-3650
(814) 467-4055
(814) 626-8161
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
08/19/2015
Last updated
05/07/2018
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