Basic Information
| Provider Information | |||||||||
| NPI: | 1326545724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AVILA-RODRIGUEZ | ||||||||
| FirstName: | ANA-MARIA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 S WOOD ST STE 820-E | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606124325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129969424 | ||||||||
| FaxNumber: | 3124134131 | ||||||||
| Practice Location | |||||||||
| Address1: | 840 S WOOD ST STE 820-E | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606124325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129969424 | ||||||||
| FaxNumber: | 3124134131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2018 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 11/16/2018 | ||||||||
| NPIReactivationDate: | 12/26/2018 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2021 | ||||||||
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.