Organization
CLINICA GUADALUPE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN ANTONIO TORRES-GARZA MD (PRESIDENT)
(773) 277-9100
Entity
Organization
Contact information
Practice address
3511 W 26TH ST, CHICAGO, IL 60623-3910
(773) 277-9100
(773) 277-0860
Mailing address
3511 W 26TH ST, CHICAGO, IL 60623-3910
(773) 277-9100
(773) 277-0860
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036068407
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001635727
BLUE CROSS BLUE SHIELD
IL
05
—
036068407
—
IL
Enumeration date
04/12/2007
Last updated
01/15/2010
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