Healthcare Provider Details

I. General information

NPI: 1396804506
Provider Name (Legal Business Name): DR. ASUNCION JUGUETA CLAVERIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W DIVISION ST STE 355
CHICAGO IL
60622-2996
US

IV. Provider business mailing address

875 VALLEY RD
LAKE FOREST IL
60045-2916
US

V. Phone/Fax

Practice location:
  • Phone: 773-342-3665
  • Fax: 773-342-3606
Mailing address:
  • Phone: 847-295-9875
  • Fax:

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: