Provider Demographics
NPI:1386476711
Name:PIMENTEL, ELSA JOSEFINA
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:JOSEFINA
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 W WESTGATE TER
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3306
Mailing Address - Country:US
Mailing Address - Phone:773-396-4782
Mailing Address - Fax:
Practice Address - Street 1:1243 W WESTGATE TER
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3306
Practice Address - Country:US
Practice Address - Phone:773-396-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty