MEDICARE: DE LA LUZ LABORATORY LLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1326972274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DE LA LUZ LABORATORY LLC

Provider Business Mailing Address
First Line	:	6027 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6027 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4301
Country	:	US
Telephone Number	:	312-415-7097
Fax Number	:

Authorized Official
Title or Position	:	LAB OWNER
Name	:	MARIA ESMERALDA AMARO HERNANDEZ
Credential	:
Telephone Number	:	312-415-7097

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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