Healthcare Provider Details

I. General information

NPI: 1578652897
Provider Name (Legal Business Name): MARIA TERESA DAVILA RDMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE 408
CHICAGO IL
60612
US

IV. Provider business mailing address

9034 SO ESCANABA AVE
CHICAGO IL
60617
US

V. Phone/Fax

Practice location:
  • Phone: 312-997-2229
  • Fax: 312-666-4163
Mailing address:
  • Phone: 773-768-7558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: