Provider Demographics
NPI:1477945442
Name:MARIA CYNTHIA YANGO-EUGENIO
Entity Type:Organization
Organization Name:MARIA CYNTHIA YANGO-EUGENIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-312-8074
Mailing Address - Street 1:1411 MCHENRY RD STE 126
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1386
Mailing Address - Country:US
Mailing Address - Phone:847-821-1071
Mailing Address - Fax:847-821-1077
Practice Address - Street 1:1411 MCHENRY RD STE 126
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1386
Practice Address - Country:US
Practice Address - Phone:847-821-1071
Practice Address - Fax:847-821-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E71092Medicare UPIN