Organization
VIRU SC
Active
Other names
Olivo Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARTHA DE SANTIAGO FNP-BC (NURSE PRACTITIONER)
(773) 423-6178
Entity
Organization
Contact information
Practice address
2412 W FULLERTON AVE, CHICAGO, IL 60647-7435
(773) 384-7977
(773) 451-8285
Mailing address
2412 W FULLERTON AVE, CHICAGO, IL 60647-7435
(773) 384-7977
(773) 451-8285
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
209.014576
IL
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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