Individual
MAE PASTORIZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
612 W 23RD ST, STERLING, IL 61081-9040
(815) 626-9020
Mailing address
7500 N RIDGE BLVD APT D, CHICAGO, IL 60645-1957
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
056008719
IL
Other
Enumeration date
10/14/2011
Last updated
10/14/2011
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