Provider Demographics
NPI:1548430911
Name:CYPRESS PROFESSIONAL GROUP
Entity Type:Organization
Organization Name:CYPRESS PROFESSIONAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:VALENCIA
Authorized Official - Last Name:BERNARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-325-4899
Mailing Address - Street 1:7055 VETERANS BLVD
Mailing Address - Street 2:UNIT C
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5634
Mailing Address - Country:US
Mailing Address - Phone:630-325-4899
Mailing Address - Fax:
Practice Address - Street 1:7055 VETERANS BLVD
Practice Address - Street 2:UNIT C
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5634
Practice Address - Country:US
Practice Address - Phone:630-325-4899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)