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General NPI Number Information
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NPI Number | 1598245276
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Entity Type | Organization
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Legal Business Name | SALUD LATINX LLC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 1952 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60608-4204
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Country | US
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Telephone | 773-254-6611
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Fax | 773-254-8590
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Provider Business Mailing Address
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Address Line | 2014 W 22ND PL
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City | CHICAGO
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State | IL
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Zip | 60608-4114
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Country | US
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Telephone | 312-998-3940
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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. RAY A MENDEZ
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Credential | MD
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Telephone | 312-998-3940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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