Provider Demographics
NPI:1598346223
Name:RAZO, PAULINA (MSCD)
Entity Type:Individual
Prefix:
First Name:PAULINA
Middle Name:
Last Name:RAZO
Suffix:
Gender:F
Credentials:MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W HOLLYWOOD AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-6500
Mailing Address - Country:US
Mailing Address - Phone:312-646-9691
Mailing Address - Fax:
Practice Address - Street 1:1025 W HOLLYWOOD AVE APT 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-6500
Practice Address - Country:US
Practice Address - Phone:312-646-9691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00000000000Medicaid