MEDICARE: EL TALLER DEL MAESTRO

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1639493299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL TALLER DEL MAESTRO

Provider Business Mailing Address
First Line	:	524 CARRIAGE DR
Second Line	:	APT. 1A
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-4095
Country	:	US
Telephone Number	:	815-209-9899
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 CARRIAGE DR
Second Line	:	APT. 1A
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-4095
Country	:	US
Telephone Number	:	815-209-9899
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FRANCISCO CANALES
Credential	:
Telephone Number	:	815-209-9899

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	03/24/2010

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Directions to “EL TALLER DEL MAESTRO ” Practice Location

Language	Start Address	Practice Location

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