Provider Demographics
NPI:1982430815
Name:LARDIZABAL, ROSANNA GARCIA
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:GARCIA
Last Name:LARDIZABAL
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 1:25969 W STEEPLEBUSH LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5213
Mailing Address - Country:US
Mailing Address - Phone:224-804-1679
Mailing Address - Fax:
Practice Address - Street 1:135 N GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3393
Practice Address - Country:US
Practice Address - Phone:224-285-0728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program