Provider Demographics
NPI:1194406686
Name:DIAZ RUPAR, RAMONA GLIZA (AUD)
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:GLIZA
Last Name:DIAZ RUPAR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:RAMONA
Other - Middle Name:GLIZA
Other - Last Name:RUPAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:9233 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND HILLS
Practice Address - State:IL
Practice Address - Zip Code:60487-5977
Practice Address - Country:US
Practice Address - Phone:630-824-1614
Practice Address - Fax:630-545-7839
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001959231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist