Healthcare Provider Details

I. General information

NPI: 1689869455
Provider Name (Legal Business Name): OFELIA B. AYUSTE M.D.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 FAIRVIEW AVE STE 100
DOWNERS GROVE IL
60515-2266
US

IV. Provider business mailing address

4121 FAIRVIEW AVE STE 100
DOWNERS GROVE IL
60515-2266
US

V. Phone/Fax

Practice location:
  • Phone: 630-971-8881
  • Fax: 630-971-8842
Mailing address:
  • Phone: 630-971-8881
  • Fax: 630-971-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OFELIA BARRIOS AYUSTE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-971-8881