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General NPI Number Information
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NPI Number | 1306218219
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Entity Type | Organization
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Legal Business Name | ANGELES EXPRESS CORP
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 1210 N PULASKI RD APT 3 1210 N PULASKI APT 3
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City | CHICAGO
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State | IL
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Zip | 60651-1909
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Country | US
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Telephone | 773-886-2599
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 N PULASKI ROAD APT.3
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City | CHICAGO
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State | IL
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Zip | 60651
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Country | US
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Telephone | 773-886-2599
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Fax |
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Authorized Official
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Title or Position | MANGER/DIRECTOR
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Name | MAYRA ALEJANDRA CHIVATA
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Credential |
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Telephone | 773-886-2599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | C13654191952
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License Number State | IL
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