Healthcare Provider Details

I. General information

NPI: 1225956642
Provider Name (Legal Business Name): GISSELA A VASQUEZ GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

3115 N KILPATRICK AVE
CHICAGO IL
60641-5241
US

V. Phone/Fax

Practice location:
  • Phone: 888-352-7874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041476283
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: