| NPI | 1578748067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA VELAZQUEZ Office Manager 708-636-8747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036079532) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036114693) |
| 174400000X Specialist (Licence: IL 036115658) | |
| 174400000X Specialist (Licence: IL 036116141) | |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: IL 209010813) | |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2013-12-02 |