Provider Demographics
NPI:1508682899
Name:CARNALLA, OSVALDO JR
Entity type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:CARNALLA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2847
Mailing Address - Country:US
Mailing Address - Phone:773-526-2894
Mailing Address - Fax:
Practice Address - Street 1:135 N ADDISON AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2857
Practice Address - Country:US
Practice Address - Phone:630-832-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician