Healthcare Provider Details

I. General information

NPI: 1578858106
Provider Name (Legal Business Name): VICTORIA RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 06/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 S MARYLAND AVE
CHICAGO IL
60637-1425
US

IV. Provider business mailing address

1124 CURTISS ST
DOWNERS GROVE IL
60515-4632
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125059377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: