Healthcare Provider Details

I. General information

NPI: 1326972274
Provider Name (Legal Business Name): DE LA LUZ LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 N CICERO AVE
CHICAGO IL
60646-4301
US

IV. Provider business mailing address

6027 N CICERO AVE
CHICAGO IL
60646-4301
US

V. Phone/Fax

Practice location:
  • Phone: 312-415-7097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MARIA ESMERALDA AMARO HERNANDEZ
Title or Position: LAB OWNER
Credential:
Phone: 312-415-7097