MEDICARE: HISPANIC HEALTH FOUNDATION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician		IL

General Provider Information

NPI Number	:	1255444170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HISPANIC HEALTH FOUNDATION, INC

Provider Business Mailing Address
First Line	:	PO BOX 388320
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-8320
Country	:	US
Telephone Number	:	773-767-4600
Fax Number	:	773-767-8320

Provider Business Practice Location Address
First Line	:	3456 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-1442
Country	:	US
Telephone Number	:	773-737-1990
Fax Number	:	773-737-4981

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN PAUL CUEVA
Credential	:	M.D.
Telephone Number	:	773-767-1990

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/22/2020

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