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NPI Code Detail

MEDICARE: SUSANA VICTORIA JESSICA ACOSTA NUNEZ DE VILLAVICENCIO MD

MEDICARE: SUSANA VICTORIA JESSICA ACOSTA NUNEZ DE VILLAVICENCIO MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1972451193
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANA VICTORIA JESSICA ACOSTA NUNEZ DE VILLAVICENCIO MD
Provider Business Mailing Address
First Line : 820 S WOOD ST STE 100
Second Line : MC 675
City : CHICAGO
State : IL
Zip : 60612-4325
Country : US
Telephone Number : 312-996-2933
Fax Number :
Provider Business Practice Location Address
First Line : 820 S WOOD ST STE 100
Second Line :
City : CHICAGO
State : IL
Zip : 60612-4325
Country : US
Telephone Number : 312-996-2933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2026
Last Update Date : 03/21/2026

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Directions to “ SUSANA VICTORIA JESSICA ACOSTA NUNEZ DE VILLAVICENCIO MD” Practice Location

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