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General NPI Number Information
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NPI Number | 1740595198
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Entity Type | Organization
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Legal Business Name | ABELARDO J. JARAVA MD SC
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 3336 N ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60657-2109
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Country | US
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Telephone | 773-472-2936
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Fax | 773-472-5306
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Provider Business Mailing Address
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Address Line | 3336 N ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60657-2109
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Country | US
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Telephone | 773-472-2936
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Fax | 773-472-5306
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ABELARDO J JARAVA
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Credential | M.D
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Telephone | 773-472-2936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036086850
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License Number State | IL
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