Healthcare Provider Details

I. General information

NPI: 1588354286
Provider Name (Legal Business Name): VANESSA VAZQUEZ GUZMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 FARGO BLVD
GENEVA IL
60134-3591
US

IV. Provider business mailing address

2425 FARGO BLVD
GENEVA IL
60134-3591
US

V. Phone/Fax

Practice location:
  • Phone: 630-232-2200
  • Fax: 630-232-1940
Mailing address:
  • Phone: 630-232-2200
  • Fax: 630-232-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036180733
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: