Healthcare Provider Details

I. General information

NPI: 1376395210
Provider Name (Legal Business Name): DANTE GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26W171 ROOSEVELT RD
WHEATON IL
60187-6002
US

IV. Provider business mailing address

555 THORNHILL DR APT 112
CAROL STREAM IL
60188-2727
US

V. Phone/Fax

Practice location:
  • Phone: 630-909-8000
  • Fax:
Mailing address:
  • Phone: 847-525-0687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: