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General NPI Number Information
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NPI Number | 1972050037
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Entity Type | Organization
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Legal Business Name | CYNTHIA CARMONA
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 7715 N HERMITAGE AVE 2E
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City | CHICAGO
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State | IL
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Zip | 60626-1033
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Country | US
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Telephone | 630-649-0636
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Fax |
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Provider Business Mailing Address
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Address Line | 7715 N HERMITAGE AVE 2E
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City | CHICAGO
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State | IL
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Zip | 60626-1033
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Country | US
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Telephone | 630-649-0636
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Fax |
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Authorized Official
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Title or Position | NP
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Name | MS. CYNTHIA CARMONA
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Credential | NP
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Telephone | 630-649-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | 209014818
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License Number State | IL
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