Healthcare Provider Details

I. General information

NPI: 1780596924
Provider Name (Legal Business Name): JENNIFER TAMAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W 35TH ST
CHICAGO IL
60609-1309
US

IV. Provider business mailing address

3627 S SEELEY AVE
CHICAGO IL
60609-1372
US

V. Phone/Fax

Practice location:
  • Phone: 773-615-5415
  • Fax:
Mailing address:
  • Phone: 708-574-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: