Basic Information
| Provider Information | |||||||||
| NPI: | 1255983474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRELLES GARCIA | ||||||||
| FirstName: | DANIELA | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1012 AUSTIN ST APT 2D | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602022758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129736878 | ||||||||
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| Practice Location | |||||||||
| Address1: | 355 RIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602023328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473164000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2019 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.