Healthcare Provider Details

I. General information

NPI: 1326286030
Provider Name (Legal Business Name): ELEANOR PAGULAYAN SA-C, RSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 GLENSIDE CIR
BOLINGBROOK IL
60490-5494
US

IV. Provider business mailing address

742 GLENSIDE CIR
BOLINGBROOK IL
60490-5494
US

V. Phone/Fax

Practice location:
  • Phone: 630-854-5229
  • Fax: 630-887-1668
Mailing address:
  • Phone: 630-854-5229
  • Fax: 630-887-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: