Provider Demographics
NPI:1932674488
Name:GOZO, VISITACION ROSEL (RN)
Entity type:Individual
Prefix:
First Name:VISITACION
Middle Name:ROSEL
Last Name:GOZO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W FULTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1262
Mailing Address - Country:US
Mailing Address - Phone:312-526-2411
Mailing Address - Fax:312-526-2329
Practice Address - Street 1:5401 S WENTWORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-6300
Practice Address - Country:US
Practice Address - Phone:773-288-6900
Practice Address - Fax:773-268-3020
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041309132163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management