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General NPI Number Information
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NPI Number | 1245034743
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Entity Type | Individual
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Provider Name | RICARDO JOSE INFANZON
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Gender | Male
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 311 N 2ND ST UNIT 203
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City | ST CHARLES
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State | IL
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Zip | 60174-1850
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Country | US
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Telephone | 630-377-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 1094 CALLE 5
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City | SAN JUAN
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State | PR
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Zip | 00927-5120
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Country | US
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Telephone | 787-507-1880
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 150114587
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License Number State | IL
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