Individual
MR. DANIEL CEBALLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
3600 W FULLERTON AVE, CHICAGO, IL 60647-2319
(773) 782-2800
Mailing address
2440 W HARRISON ST APT 4, CHICAGO, IL 60612-3788
(312) 421-3219
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209-003925
IL
Other
Enumeration date
11/30/2006
Last updated
09/29/2020
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