MEDICARE: ZULIA ACUNA BORRELL SA-C

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	246ZC0007X	Surgical Assistant	20-438	IL

General Provider Information

NPI Number	:	1568065977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZULIA ACUNA BORRELL SA-C

Provider Business Mailing Address
First Line	:	8665 GRAND AVE APT 202
Second Line	:
City	:	RIVER GROVE
State	:	IL
Zip	:	60171-1342
Country	:	US
Telephone Number	:	773-633-7166
Fax Number	:

Provider Business Practice Location Address
First Line	:	8665 GRAND AVE APT 202
Second Line	:
City	:	RIVER GROVE
State	:	IL
Zip	:	60171-1342
Country	:	US
Telephone Number	:	773-633-7166
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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