Provider Demographics
NPI:1629434600
Name:MAURICIO, ESTELA CRUZ
Entity Type:Individual
Prefix:MS
First Name:ESTELA
Middle Name:CRUZ
Last Name:MAURICIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 AMHERST CT
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1708
Mailing Address - Country:US
Mailing Address - Phone:847-922-8172
Mailing Address - Fax:
Practice Address - Street 1:308 AMHERST CT
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1708
Practice Address - Country:US
Practice Address - Phone:847-922-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009004225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist