Healthcare Provider Details

I. General information

NPI: 1194032326
Provider Name (Legal Business Name): ROVI DOLORES AQUINO ORIGENES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E SCHILLER ST STE 318
ELMHURST IL
60126-2823
US

IV. Provider business mailing address

110 E SCHILLER ST STE 318
ELMHURST IL
60126-2823
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-1775
  • Fax: 630-832-3078
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209008196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: