Provider Demographics
NPI:1134343320
Name:G & L ALCALA PEDIATRIC PRACTICE
Entity type:Organization
Organization Name:G & L ALCALA PEDIATRIC PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIBERATO
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALCALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-725-0007
Mailing Address - Street 1:301 N SPRINGFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6590
Mailing Address - Country:US
Mailing Address - Phone:815-725-0007
Mailing Address - Fax:815-725-4579
Practice Address - Street 1:301 N SPRINGFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6590
Practice Address - Country:US
Practice Address - Phone:815-725-0007
Practice Address - Fax:815-725-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0366047016208000000X
IL0366091730208000000X
IL0362779754208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty