NPIMap

Organization Active NPI

Ma. Olivia R. San Diego, M.D., S.C.

  • Pediatrics Physician
  • Chicago, IL
National Provider Identifier
1245580653
Registry record updated Sep 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036-130487 Issued in IL
Legal business name
MA. OLIVIA R. SAN DIEGO, M.D., S.C.
Practice address
1044 N Mozart St
Suite 205
Chicago, IL 60622-2789
Phone
(773) 489-2913
Fax
(773) 489-7330
NPI assigned
Sep 12, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2012

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

Authorized official

Name
Dr. Ma. Olivia Roque San Diego, M.D.NPI 1285842997
Title
Director
Phone
(973) 653-6119

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 036-130487 IL Primary

Addresses

Primary practice location

1044 N Mozart St
Suite 205
Chicago, IL 60622-2789

Mailing address

1044 N Mozart St
Suite 205
Chicago, IL 60622-2789
Phone (773) 489-2913

National Provider Directory

National Provider Directory

Locations

1044 N Mozart St
Ste 205
Chicago, IL 60622
Phone (773) 489-2912

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347408000000",
    "number": "1245580653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 N MOZART ST",
            "address_2": "SUITE 205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222789",
            "telephone_number": "773-489-2913",
            "fax_number": "773-489-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 N MOZART ST",
            "address_2": "SUITE 205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222789",
            "telephone_number": "773-489-2913",
            "fax_number": "773-489-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MA. OLIVIA R. SAN DIEGO, M.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-12",
        "last_updated": "2012-09-12",
        "status": "A",
        "authorized_official_last_name": "SAN DIEGO",
        "authorized_official_first_name": "MA. OLIVIA",
        "authorized_official_middle_name": "ROQUE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "973-653-6119",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-130487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; 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.