Jessie L Mabaquiao MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036082232 Issued in IL

Legal business name

JESSIE L MABAQUIAO MD

Practice address

855 W 103Rd St
Suite 100
Chicago, IL 60643-2357

Phone

(773) 239-9600

Fax

(773) 239-9601

NPI assigned

Aug 21, 2012

Organization subpart

No

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

Authorized official

Name

Angela J Ratcliffe

Title

Administrator

Phone

(773) 239-9600

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345680000000",
    "number": "1437407517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 W 103RD ST",
            "address_2": "SUITE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606432357",
            "telephone_number": "773-239-9600",
            "fax_number": "773-239-9601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 W 103RD ST",
            "address_2": "SUITE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606432357",
            "telephone_number": "773-239-9600",
            "fax_number": "773-239-9601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSIE L MABAQUIAO MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-21",
        "last_updated": "2012-08-23",
        "status": "A",
        "authorized_official_last_name": "RATCLIFFE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "773-239-9600"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036082232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036082232",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jessica Weisbach, LLC
• Jessie Brown Memoria VA Hospital
• Patricia D. Jessie, L.C.P.C.
• Maureen Jesuthasan, LPC
• Pim Jetanalin, M.D.
• Shannon Jeter
• Jetset Wellcare LLC

• Psychiatry Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.