Provider Demographics
NPI:1316129638
Name:ROSITA S. HERNANDEZ SC
Entity type:Organization
Organization Name:ROSITA S. HERNANDEZ SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-873-7800
Mailing Address - Street 1:6853 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-1868
Mailing Address - Country:US
Mailing Address - Phone:773-873-7800
Mailing Address - Fax:773-873-7800
Practice Address - Street 1:6853 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1868
Practice Address - Country:US
Practice Address - Phone:773-873-7800
Practice Address - Fax:773-873-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210266Medicare PIN