Healthcare Provider Details

I. General information

NPI: 1104038801
Provider Name (Legal Business Name): MARIA CEBRERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3104 N. NATOMA
CHICAGO IL
60634
US

IV. Provider business mailing address

3104 N. NATOMA
CHICAGO IL
60634
US

V. Phone/Fax

Practice location:
  • Phone: 773-680-0921
  • Fax: 773-237-4345
Mailing address:
  • Phone: 773-680-0921
  • Fax: 773-237-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: