NPIMap

Organization Active NPI

La Sagrada Familia Medical Clinic LLC

  • Primary Care Clinic/Center
  • Cicero, IL
National Provider Identifier
1164749594
Registry record updated Dec 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
036-114621 Issued in IL
Legal business name
LA SAGRADA FAMILIA MEDICAL CLINIC LLC
Practice address
6013 W Cermak Rd
Cicero, IL 60804-2018
Phone
(708) 222-9193
Fax
(708) 222-9198
NPI assigned
Apr 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Francisco Avalos, M.D.
Title
Medical Director
Phone
(708) 222-9193

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 036-114621 IL Primary

Addresses

Primary practice location

6013 W Cermak Rd
Cicero, IL 60804-2018

Mailing address

6013 W Cermak Rd
Cicero, IL 60804-2018
Phone (708) 222-9193

National Provider Directory

National Provider Directory

Locations

6013 W Cermak Rd
Cicero, IL 60804
Phone (708) 222-9193

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291420800000",
    "number": "1164749594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6013 W CERMAK RD",
            "city": "CICERO",
            "state": "IL",
            "postal_code": "608042018",
            "telephone_number": "708-222-9193",
            "fax_number": "708-222-9198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6013 W CERMAK RD",
            "city": "CICERO",
            "state": "IL",
            "postal_code": "608042018",
            "telephone_number": "708-222-9193",
            "fax_number": "708-222-9198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA SAGRADA FAMILIA MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-25",
        "last_updated": "2010-12-04",
        "status": "A",
        "authorized_official_last_name": "AVALOS",
        "authorized_official_first_name": "FRANCISCO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "708-222-9193",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036-114621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cicero, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.