Healthcare Provider Details

I. General information

NPI: 1083876064
Provider Name (Legal Business Name): ESTELA S RUTIAGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 EAST RIVERSIDE BLVD
CHICAGO IL
60673-1296
US

IV. Provider business mailing address

8201 E RIVERSIDE BLVD
ROCKFORD IL
61114-2300
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-7000
  • Fax: 815-968-4795
Mailing address:
  • Phone: 815-971-7000
  • Fax: 815-968-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036128008
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number036.128008
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52785
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: