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General NPI Number Information
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NPI Number | 1134343320
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Entity Type | Organization
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Legal Business Name | G & L ALCALA PEDIATRIC PRACTICE
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 N SPRINGFIELD AVENUE
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City | JOLIET
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State | IL
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Zip | 60435-6590
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Country | US
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Telephone | 815-725-0007
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Fax | 815-725-4579
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Provider Business Mailing Address
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Address Line | 301 N SPRINGFIELD AVENUE
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City | JOLIET
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State | IL
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Zip | 60435-6590
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Country | US
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Telephone | 815-725-0007
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Fax | 815-725-4579
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Authorized Official
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Title or Position | OWNER
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Name | LIBERATO D ALCALA
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Credential | MD
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Telephone | 815-725-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0366047016
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0366091730
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0362779754
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License Number State | IL
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