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NPI Code Detail

MEDICARE: URBANO ANACLETO-DOMINGUEZ JR. MA

MEDICARE: URBANO ANACLETO-DOMINGUEZ JR. MA
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
1101YP2500XProfessional CounselorIL

General Provider Information

NPI Number : 1578218368
Entity Type Code : Individual
Provider Name (Legal Business Name) : URBANO ANACLETO-DOMINGUEZ JR. MA
Provider Business Mailing Address
First Line : 6815 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60638-4048
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6815 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60638-4048
Country : US
Telephone Number : 708-979-6266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2022
Last Update Date : 02/21/2022

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Directions to “ URBANO ANACLETO-DOMINGUEZ JR. MA” Practice Location

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