Healthcare Provider Details

I. General information

NPI: 1003772617
Provider Name (Legal Business Name): VERONICA MARTINEZ GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2025
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5139 N ASHLAND AVE APT 1
CHICAGO IL
60640-7631
US

IV. Provider business mailing address

5139 N ASHLAND AVE APT 1
CHICAGO IL
60640-7631
US

V. Phone/Fax

Practice location:
  • Phone: 787-307-5601
  • Fax:
Mailing address:
  • Phone: 787-307-5601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: