Provider Demographics
NPI:1356109300
Name:PLASENCIA PEDIATRICS INC
Entity type:Organization
Organization Name:PLASENCIA PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:PLASENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-691-1407
Mailing Address - Street 1:5939 W DIVERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1155
Mailing Address - Country:US
Mailing Address - Phone:773-637-1600
Mailing Address - Fax:773-637-1520
Practice Address - Street 1:5939 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1155
Practice Address - Country:US
Practice Address - Phone:773-637-1600
Practice Address - Fax:773-637-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty