Individual
JORGE MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3607 S WOLCOTT AVE, CHICAGO, IL 60609-1236
(708) 995-3858
Mailing address
3607 S WOLCOTT AVE, CHICAGO, IL 60609-1236
(708) 995-3858
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
16505
IL
Other
Enumeration date
09/27/2015
Last updated
09/27/2015
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