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General NPI Number Information
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NPI Number | 1215402193
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Entity Type | Individual
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Provider Name | RICARDO TOVAR VEGA Q.M.H.P., M.S.W.,
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Gender | Male
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 441 W OAKDALE AVE APT 3D1206
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City | CHICAGO
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State | IL
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Zip | 60657-5961
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Country | US
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Telephone | 773-642-6069
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Fax |
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Provider Business Mailing Address
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Address Line | 441 W OAKDALE AVE APT 3D
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City | CHICAGO
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State | IL
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Zip | 60657-5914
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Country | US
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Telephone | 773-642-6069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | IL
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