Healthcare Provider Details

I. General information

NPI: 1255444170
Provider Name (Legal Business Name): HISPANIC HEALTH FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3456 W 79TH ST
CHICAGO IL
60652-1442
US

IV. Provider business mailing address

PO BOX 388320
CHICAGO IL
60638-8320
US

V. Phone/Fax

Practice location:
  • Phone: 773-737-1990
  • Fax: 773-737-4981
Mailing address:
  • Phone: 773-767-4600
  • Fax: 773-767-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: JOHN PAUL CUEVA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-767-1990