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NPI Code Detail

MEDICARE: MR. DANIEL CEBALLOS NURSE PRACTITIONER

MEDICARE: MR. DANIEL CEBALLOS NURSE PRACTITIONER
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
1363LA2200XAdult Health Nurse Practitioner209-003925IL

General Provider Information

NPI Number : 1659449767
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DANIEL CEBALLOS NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 2440 W HARRISON ST APT 4
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3788
Country : US
Telephone Number : 312-421-3219
Fax Number :
Provider Business Practice Location Address
First Line : 3600 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2319
Country : US
Telephone Number : 773-782-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 09/29/2020

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