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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