Licea, Rosaura

Licea, Rosaura is an individual health care provider with primary practice located at 5712 W 35Th St , Cicero IL 60804-4222. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Licea, Rosaura can be contacted via phone (708) 656-5485.

Contact Information

Primary practice address
5712 W 35Th St Cicero IL 60804-4222
Phone: (708) 656-5485
Fax: (708) 656-5657
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036-091269 Illinois

Profile Details

NPI number 1548299225
LBN Legal business name Licea, Rosaura
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 3rd, 2006
Last updated Jul 16th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1548299225 NPPES
Illinois MEDICAID 036091269
Illinois Other K30405

Popular Providers