Healthcare Provider Details

I. General information

NPI: 1154556413
Provider Name (Legal Business Name): ABRAHAM JACOB SAENZ B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 W 55TH ST 2ND FL
CHICAGO IL
60632-4628
US

IV. Provider business mailing address

4308 W 55TH ST 2ND FL
CHICAGO IL
60632-4628
US

V. Phone/Fax

Practice location:
  • Phone: 312-451-4814
  • Fax:
Mailing address:
  • Phone: 312-451-4814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: