Provider Demographics
NPI:1972050037
Name:CYNTHIA CARMONA
Entity Type:Organization
Organization Name:CYNTHIA CARMONA
Other - Org Name:CYNTHIA CARMONA
Other - Org Type:Other Name
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:630-649-0636
Mailing Address - Street 1:7715 N HERMITAGE AVE
Mailing Address - Street 2:2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1033
Mailing Address - Country:US
Mailing Address - Phone:630-649-0636
Mailing Address - Fax:
Practice Address - Street 1:7715 N HERMITAGE AVE
Practice Address - Street 2:2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1033
Practice Address - Country:US
Practice Address - Phone:630-649-0636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014818261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy