| NPI | 1679129977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK MABAQUIAO President 773-401-6275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2019-08-13 |