Individual
ROSE AVALOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3062 E 91ST ST, CHICAGO, IL 60617-4401
(773) 371-2900
(773) 371-2950
Mailing address
3062 E 91ST ST, CHICAGO, IL 60617-4401
(773) 371-2900
(773) 371-2950
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362167940
—
IL
Enumeration date
07/08/2015
Last updated
07/08/2015
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