Healthcare Provider Details

I. General information

NPI: 1598214934
Provider Name (Legal Business Name): SERVICIOS PROFESIONALEZ GONZALEZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 E CHICAGO ST 2ND FLOOR
ELGIN IL
60120-5524
US

IV. Provider business mailing address

593 5TH AVE 1ST FLOOR
AURORA IL
60505-5180
US

V. Phone/Fax

Practice location:
  • Phone: 224-281-3768
  • Fax: 630-723-6196
Mailing address:
  • Phone: 630-636-8939
  • Fax: 630-723-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS YANIN GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 630-639-1627