Provider Demographics
NPI:1346998424
Name:VENEGAS, ALEXUS LUZ
Entity Type:Individual
Prefix:
First Name:ALEXUS
Middle Name:LUZ
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3518
Mailing Address - Country:US
Mailing Address - Phone:847-347-7277
Mailing Address - Fax:
Practice Address - Street 1:1585 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-3518
Practice Address - Country:US
Practice Address - Phone:847-347-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer