Provider Demographics
NPI:1013999481
Name:LEON-JAUREGUI, DULCES (MD)
Entity Type:Individual
Prefix:
First Name:DULCES
Middle Name:
Last Name:LEON-JAUREGUI
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 1:7634 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3110
Mailing Address - Country:US
Mailing Address - Phone:773-637-5644
Mailing Address - Fax:773-625-0953
Practice Address - Street 1:7634 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3110
Practice Address - Country:US
Practice Address - Phone:773-625-6610
Practice Address - Fax:773-625-0953
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088095Medicaid
ILL59359Medicare UPIN
L59359 750550Medicare ID - Type Unspecified