Organization
MA. OLIVIA R. SAN DIEGO, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MA. OLIVIA ROQUE SAN DIEGO M.D. (DIRECTOR)
(973) 653-6119
Entity
Organization
Contact information
Practice address
1044 N MOZART ST, SUITE 205, CHICAGO, IL 60622-2789
(773) 489-2913
(773) 489-7330
Mailing address
1044 N MOZART ST, SUITE 205, CHICAGO, IL 60622-2789
(773) 489-2913
(773) 489-7330
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-130487
IL
Other
Enumeration date
09/12/2012
Last updated
09/12/2012
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