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General NPI Number Information
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NPI Number | 1619365061
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Entity Type | Organization
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Legal Business Name | HAVANA HEALTH,LLC
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 3033 W JEFFERSON ST STE. 201
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City | JOLIET
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State | IL
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Zip | 60435-5261
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Country | US
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Telephone | 815-714-2517
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Fax | 815-714-2719
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Provider Business Mailing Address
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Address Line | 3033 W JEFFERSON ST STE. 201
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City | JOLIET
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State | IL
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Zip | 60435-5261
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Country | US
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Telephone | 815-714-2517
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Fax | 815-714-2719
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. OMAR GARCIA
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Credential | M.D., M.P.H
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Telephone | 815-714-2517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 036.124389
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License Number State | IL
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