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NPI Code Detail

MEDICARE: MR. JOSE QUIROGA PERALTA

MEDICARE: MR. JOSE QUIROGA PERALTA
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
1124Q00000XDental HygienistIL

General Provider Information

NPI Number : 1821282625
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSE QUIROGA PERALTA
Provider Business Mailing Address
First Line : 2127 GREEN BAY RD
Second Line :
City : NORTH CHICAGO
State : IL
Zip : 60064-2801
Country : US
Telephone Number : 847-689-3800
Fax Number : 847-689-0191
Provider Business Practice Location Address
First Line : 2127 GREEN BAY RD
Second Line :
City : NORTH CHICAGO
State : IL
Zip : 60064-2801
Country : US
Telephone Number : 847-689-3800
Fax Number : 847-689-0191
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2007
Last Update Date : 09/05/2007

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Directions to “ MR. JOSE QUIROGA PERALTA ” Practice Location

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