MEDICARE: ANA ROSA CORIA ALVAREZ

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	104100000X	Social Worker	150.105693	IL

General Provider Information

NPI Number	:	1487301636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA ROSA CORIA ALVAREZ

Provider Business Mailing Address
First Line	:	966 W 21ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 S KOSTNER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4842
Country	:	US
Telephone Number	:	773-254-1400
Fax Number	:

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

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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