1215402193 NPI number — MR. RICARDO TOVAR VEGA Q.M.H.P., M.S.W.,

Table of content: EMILY L PAGE MSN, FNP-C (NPI 1043839111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215402193 NPI number — MR. RICARDO TOVAR VEGA Q.M.H.P., M.S.W.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOVAR VEGA
Provider First Name:
RICARDO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Q.M.H.P., M.S.W.,
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215402193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
441 W OAKDALE AVE APT 3D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657-5914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-642-6069
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 W OAKDALE AVE APT 3D1206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-5961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-642-6069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36-2235147 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".