Healthcare Provider Details

I. General information

NPI: 1346998424
Provider Name (Legal Business Name): ALEXUS LUZ VENEGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 JEFFERSON RD
HOFFMAN ESTATES IL
60169-3518
US

IV. Provider business mailing address

1585 JEFFERSON RD
HOFFMAN ESTATES IL
60169-3518
US

V. Phone/Fax

Practice location:
  • Phone: 847-347-7277
  • Fax:
Mailing address:
  • Phone: 847-347-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: