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General NPI Number Information
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NPI Number | 1821443839
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Entity Type | Individual
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Provider Name | LAURA VILLAVICENCIO BRIZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 150 E HURON ST
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City | CHICAGO
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State | IL
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Zip | 60611-2999
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Country | US
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Telephone | 773-572-8383
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Fax | 312-915-0249
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Provider Business Mailing Address
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Address Line | 1627 N FAIRFIELD AVE 3
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City | CHICAGO
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State | IL
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Zip | 60647-5207
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Country | US
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Telephone | 813-504-2013
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036.152847
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License Number State | IL
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