Healthcare Provider Details

I. General information

NPI: 1942231469
Provider Name (Legal Business Name): ADELINA DEL ROSARIO MOYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 W NORTH AVE
CHICAGO IL
60639-4346
US

IV. Provider business mailing address

416 JUSTINA ST
HINSDALE IL
60521-2419
US

V. Phone/Fax

Practice location:
  • Phone: 773-889-0166
  • Fax:
Mailing address:
  • Phone: 630-655-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: