Healthcare Provider Details

I. General information

NPI: 1407608086
Provider Name (Legal Business Name): LAZARO ANGUIANO MUNOZ FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LAZARO ANGUIANO

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E OGDEN AVE STE 202
WESTMONT IL
60559-1296
US

IV. Provider business mailing address

2438 BERRY ST
JOLIET IL
60435-1407
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-9785
  • Fax:
Mailing address:
  • Phone: 573-855-8538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number209030383
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: