Provider Demographics
NPI:1639493299
Name:EL TALLER DEL MAESTRO
Entity Type:Organization
Organization Name:EL TALLER DEL MAESTRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-209-9899
Mailing Address - Street 1:524 CARRIAGE DR
Mailing Address - Street 2:APT. 1A
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-4095
Mailing Address - Country:US
Mailing Address - Phone:815-209-9899
Mailing Address - Fax:
Practice Address - Street 1:524 CARRIAGE DR
Practice Address - Street 2:APT. 1A
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-4095
Practice Address - Country:US
Practice Address - Phone:815-209-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency