Provider Demographics
NPI:1013483205
Name:PATINO, MAYRA (BS)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:PATINO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N HERMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1161
Mailing Address - Country:US
Mailing Address - Phone:312-948-6539
Mailing Address - Fax:
Practice Address - Street 1:1800 N HERMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1161
Practice Address - Country:US
Practice Address - Phone:312-948-6539
Practice Address - Fax:312-382-1612
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator