Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 036137123 | IL |
NPI | 1366708117 |
---|---|
Provider Name | Dr. Ria Luz Parcellano |
First Address | Chicago, IL 60607-1644 |
Second Address | Glenview, IL 60025-2121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 20/12/2021 |