Healthcare Provider Details

I. General information

NPI: 1184653040
Provider Name (Legal Business Name): HISPANIC REGIONAL CLINICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5544 W BELMONT AVE
CHICAGO IL
60641-4129
US

IV. Provider business mailing address

5544 W BELMONT AVE
CHICAGO IL
60641-4129
US

V. Phone/Fax

Practice location:
  • Phone: 773-685-7816
  • Fax: 773-685-4830
Mailing address:
  • Phone: 773-685-7816
  • Fax: 773-685-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036045354
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number036039405
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036083463
License Number StateIL

VIII. Authorized Official

Name: DR. RAMON J CASTRO
Title or Position: PRESIDENT
Credential: MD
Phone: 773-685-7816