Basic Information
| Provider Information | |||||||||
| NPI: | 1902399306 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAFRA ACOSTA | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | ANDREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1431 N WESTERN AVE STE 406 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606221774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126335841 | ||||||||
| FaxNumber: | 3124915020 | ||||||||
| Practice Location | |||||||||
| Address1: | 1431 N WESTERN AVE STE 406 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606221774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126335841 | ||||||||
| FaxNumber: | 3124915020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2018 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.157080 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.