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General NPI Number Information
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NPI Number | 1932518750
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Entity Type | Individual
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Provider Name | AXA MARIA YOSMAR ANAYA NOUBLEAU M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 4700 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60632
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Country | US
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Telephone | 773-584-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 S CALIFORNIA AVE STE 100
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City | CHICAGO
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State | IL
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Zip | 60608-2486
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Country | US
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Telephone | 773-584-6200
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 036.143018
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License Number State | IL
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