NPI | 1700987328 |
---|---|
Entity Type | Organization |
Authorized Contact | JOSE RIOS V.P. 815-744-8554 |
Organization Subpart ? | No |
Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: IL 036108932) |
Additional Taxonomies | 208200000X Plastic Surgery (Licence: IL 036109103) |
363AM0700X Physician Assistant, Medical (Licence: IL 085002224) | |
Enumeration Date | 2006-09-26 |
Last Update Date | 2017-03-22 |