Healthcare Provider Details

I. General information

NPI: 1245183342
Provider Name (Legal Business Name): LUZ DARY VALDES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5719 W FULLERTON AVE APT 1F
CHICAGO IL
60639-2337
US

IV. Provider business mailing address

2201 N 72ND CT
ELMWOOD PARK IL
60707-2722
US

V. Phone/Fax

Practice location:
  • Phone: 773-865-2384
  • Fax:
Mailing address:
  • Phone: 773-698-5645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: