MEDICARE: MARIA NELFA SORRONDA REGENCIA MT

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	246RM2200X	Medical Laboratory Technician	144225	IL

General Provider Information

NPI Number	:	1437034881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA NELFA SORRONDA REGENCIA MT

Provider Business Mailing Address
First Line	:	9213 PARKLANE AVE
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-2837
Country	:	US
Telephone Number	:	847-329-7500
Fax Number	:	847-807-4403

Provider Business Practice Location Address
First Line	:	9213 PARKLANE AVE
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-2837
Country	:	US
Telephone Number	:	847-329-7500
Fax Number	:	847-807-4403

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

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	08/06/2025

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