Provider Demographics
NPI:1942696141
Name:SERVICIOS PROFESIONALEZ GONZALEZ INC..
Entity Type:Organization
Organization Name:SERVICIOS PROFESIONALEZ GONZALEZ INC..
Other - Org Name:CLINICA MEDICA DEL NINO JESUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:YANIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-639-1627
Mailing Address - Street 1:593 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-5180
Mailing Address - Country:US
Mailing Address - Phone:630-636-8939
Mailing Address - Fax:630-723-6196
Practice Address - Street 1:593 5TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-5180
Practice Address - Country:US
Practice Address - Phone:630-636-8939
Practice Address - Fax:630-723-6196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERVICIOS PROFESIONALES GONZALEZ INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty