Healthcare Provider Details

I. General information

NPI: 1164114807
Provider Name (Legal Business Name): LARYSA JURIGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 HOBSON RD STE 232
NAPERVILLE IL
60540-8138
US

IV. Provider business mailing address

219 NEBRASKA ST
GENEVA IL
60134-2823
US

V. Phone/Fax

Practice location:
  • Phone: 630-946-6554
  • Fax: 877-458-3984
Mailing address:
  • Phone: 217-276-3757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number209.026358
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: