Healthcare Provider Details

I. General information

NPI: 1205837119
Provider Name (Legal Business Name): WOMEN FIRST SPECIALISTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N ELSTON AVE
CHICAGO IL
60646-4703
US

IV. Provider business mailing address

6121 N ELSTON AVE
CHICAGO IL
60646-4703
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-0209
  • Fax: 773-792-0112
Mailing address:
  • Phone: 773-792-0209
  • Fax: 773-792-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36059468
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number36112532
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number36122486
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36087120
License Number StateIL

VIII. Authorized Official

Name: RAYNELDA HIDALGO
Title or Position: PRESIDENT
Credential: MD
Phone: 773-792-0209