Provider Demographics
NPI:1437711512
Name:ERICA VEGUILLA MD LLC
Entity Type:Organization
Organization Name:ERICA VEGUILLA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGUILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-229-4396
Mailing Address - Street 1:1332 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5006
Mailing Address - Country:US
Mailing Address - Phone:630-229-4396
Mailing Address - Fax:
Practice Address - Street 1:1240 IROQUOIS AVE STE 200
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8538
Practice Address - Country:US
Practice Address - Phone:630-229-4396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty