Healthcare Provider Details

I. General information

NPI: 1134294531
Provider Name (Legal Business Name): RAUL N MOSQUERA, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE SUITE 605
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

5140 N CALIFORNIA AVE SUITE 605
CHICAGO IL
60625-3645
US

V. Phone/Fax

Practice location:
  • Phone: 773-561-0088
  • Fax: 773-561-2927
Mailing address:
  • Phone: 773-561-0088
  • Fax: 773-561-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: RAUL N MOSQUERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-561-0088