Organization
ANGELICA CORNEJO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELICA CORNEJO (OWNER)
(773) 331-4029
Entity
Organization
Contact information
Practice address
10725 S WESTERN AVE, CHICAGO, IL 60643-3217
(773) 270-1042
Mailing address
1318 W 107TH ST, CHICAGO, IL 60643-3632
(773) 331-4029
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/07/2022
Last updated
12/07/2022
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