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Organization
WEST CENTRAL ALLERGY CENTER S.C.
Active
Organization
WEST CENTRAL ALLERGY CENTER S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANILO GUNGON CAPATI M.D. (PRESIDENT)
(309) 685-1038
Entity
Organization
Contact information
Practice address
2514 W SCENIC DR, PEORIA, IL 61615-3825
(309) 685-1038
Mailing address
2514 W SCENIC DR, PEORIA, IL 61615-3825
(309) 685-1038
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007232040
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/24/2007
Last updated
02/05/2008
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