Healthcare Provider Details

I. General information

NPI: 1518489897
Provider Name (Legal Business Name): FREDY DAVID VALERO HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2017
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 S CALIFORNIA AVE
CHICAGO IL
60632-2016
US

IV. Provider business mailing address

2001 S CALIFORNIA AVE STE 100
CHICAGO IL
60608-2486
US

V. Phone/Fax

Practice location:
  • Phone: 773-584-6200
  • Fax: 844-285-1003
Mailing address:
  • Phone: 773-584-6200
  • Fax: 844-285-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036151660
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: