Basic Information
| Provider Information | |||||||||
| NPI: | 1922119957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOMEZ-TORRES | ||||||||
| FirstName: | AILEEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 W 26TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606233824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735425203 | ||||||||
| FaxNumber: | 7735425841 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 W 26TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606233824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735425203 | ||||||||
| FaxNumber: | 7735425841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 05/13/2012 | ||||||||
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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 | 208000000X | 036-103472 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 036-103472 | 01 | IL | STATE LICENSE | OTHER |