Individual
EDITH MATA ICABALCETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SA-C
Contact information
Practice address
8133 VALLEY DR, PALOS HILLS, IL 60465-2239
(872) 210-7324
(872) 210-7324
Mailing address
3524 W 65TH ST, CHICAGO, IL 60629-3721
(872) 210-7324
(708) 398-8800
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
238000842
—
Other
Enumeration date
12/22/2025
Last updated
12/22/2025
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