Individual
GUADALUPE BOCANEGRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9241 S ROBERTS RD, HICKORY HILLS, IL 60457-3809
(630) 809-9041
Mailing address
9241 S ROBERTS RD, HICKORY HILLS, IL 60457-3809
(630) 809-9041
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
605340
TX
174400000X
Specialist
—
IL
246RP1900X
Phlebotomy Technician
Primary
20-0204R15
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D2190321
LABORATORY DIRECTOR
IL
01
—
20-0204R15
PHLEBOTOMY
MD
01
—
605340
EMT
TX
Enumeration date
08/16/2020
Last updated
11/23/2020
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