Individual
DIEGO PUENTEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1117 SUMMER ST, HAMMOND, IN 46320-2141
(219) 712-3043
Mailing address
1117 SUMMER ST, HAMMOND, IN 46320-2141
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
057.000381
IL
314000000X
Skilled Nursing Facility
Primary
057.000381
IL
Other
Enumeration date
08/05/2015
Last updated
08/05/2015
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