Healthcare Provider Details

I. General information

NPI: 1245158880
Provider Name (Legal Business Name): PAULINA CARABANTES ELESSAWY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 FOX TROT
DIXON IL
61021-3286
US

IV. Provider business mailing address

124 FOX TROT
DIXON IL
61021-3286
US

V. Phone/Fax

Practice location:
  • Phone: 630-998-4182
  • Fax:
Mailing address:
  • Phone: 630-998-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1300324
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: