Individual
MR. LUIS VICTOR FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2410 SAMPSON ST, GREAT LAKES, IL 60088-2942
(847) 688-2469
Mailing address
2410 SAMPSON ST., BLDG 237, GREAT LAKES, IL 60088
(847) 688-2469
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/27/2012
Last updated
04/27/2012
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