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General NPI Number Information
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NPI Number | 1437711512
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Entity Type | Organization
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Legal Business Name | ERICA VEGUILLA MD LLC
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 1240 IROQUOIS AVE STE 200
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City | NAPERVILLE
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State | IL
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Zip | 60563-8538
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Country | US
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Telephone | 630-229-4396
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Fax |
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Provider Business Mailing Address
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Address Line | 1332 W JEFFERSON AVE
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City | NAPERVILLE
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State | IL
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Zip | 60540-5006
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Country | US
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Telephone | 630-229-4396
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ERICA VEGUILLA
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Credential | MD
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Telephone | 630-229-4396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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