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General NPI Number Information
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NPI Number | 1568072288
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Entity Type | Individual
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Provider Name | JAIME VIRAMONTES JR. CSFA
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Gender | Male
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 2725 TECHNOLOGY DR
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City | LOMBARD
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State | IL
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Zip | 60148-5675
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Country | US
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Telephone | 630-946-2700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1027
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City | LA GRANGE PARK
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State | IL
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Zip | 60526-9127
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Country | US
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Telephone | 331-777-0562
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 238.000686
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License Number State | IL
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