Healthcare Provider Details

I. General information

NPI: 1356399042
Provider Name (Legal Business Name): LETICIA VALDIVIEZ RN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 CHILDRENS PLAZA BOX 30
CHICAGO IL
60614-3394
US

IV. Provider business mailing address

2300 CHILDRENS PLAZA BOX 30
CHICAGO IL
60614-3394
US

V. Phone/Fax

Practice location:
  • Phone: 773-868-8903
  • Fax: 773-868-8016
Mailing address:
  • Phone: 773-868-8903
  • Fax: 773-868-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: