Healthcare Provider Details

I. General information

NPI: 1235065269
Provider Name (Legal Business Name): ZITLALY VILLAFUERTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 S PAULINA ST
CHICAGO IL
60608-2719
US

IV. Provider business mailing address

3127 S SPRINGFIELD AVE
CHICAGO IL
60623-4944
US

V. Phone/Fax

Practice location:
  • Phone: 312-666-3883
  • Fax:
Mailing address:
  • Phone: 312-721-7992
  • Fax:

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: