MEDICARE: MRS. CARMEN DEBO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171R00000X	Interpreter

General Provider Information

NPI Number	:	1306279419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN DEBO

Provider Business Mailing Address
First Line	:	2147 N TRIPP AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3609
Country	:	US
Telephone Number	:	773-603-6623
Fax Number	:

Provider Business Practice Location Address
First Line	:	2147 N TRIPP AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3609
Country	:	US
Telephone Number	:	773-603-6623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	08/12/2013

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