Provider Demographics
NPI:1942231469
Name:MOYA, ADELINA DEL ROSARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ADELINA
Middle Name:DEL ROSARIO
Last Name:MOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 JUSTINA ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2419
Mailing Address - Country:US
Mailing Address - Phone:630-655-0596
Mailing Address - Fax:
Practice Address - Street 1:5455 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-4346
Practice Address - Country:US
Practice Address - Phone:773-889-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
715870Medicare ID - Type Unspecified