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General NPI Number Information
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NPI Number | 1649660366
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Entity Type | Organization
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Legal Business Name | C & G DIAGNOSTICS LTD
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 770 PASQUINELLI DR STE 418
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City | WESTMONT
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State | IL
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Zip | 60559-5566
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Country | US
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Telephone | 773-767-2266
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Fax | 773-767-4380
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Provider Business Mailing Address
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Address Line | 4007 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60629-4605
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Country | US
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Telephone | 773-767-2266
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Fax | 773-767-4380
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE A CAVERO
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Credential | MD
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Telephone | 773-767-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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