Provider Demographics
NPI:1568072288
Name:VIRAMONTES, JAIME JR (CSFA)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:VIRAMONTES
Suffix:JR
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-9127
Mailing Address - Country:US
Mailing Address - Phone:331-777-0562
Mailing Address - Fax:
Practice Address - Street 1:2725 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5675
Practice Address - Country:US
Practice Address - Phone:630-946-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000686246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant