NPIMap

Organization Active NPI

Viru SC

Doing business as Olivo Wellness Center

  • Primary Care Clinic/Center
  • Chicago, IL
National Provider Identifier
1558812362
Registry record updated Oct 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
209.014576 Issued in IL
Legal business name
VIRU SC
Doing business as
Olivo Wellness Center
Practice address
2412 W Fullerton Ave
Chicago, IL 60647-7435
Phone
(773) 384-7977
Fax
(773) 451-8285
NPI assigned
Oct 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2016

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

Authorized official

Name
Mrs. Martha De Santiago, FNP-BC
Title
Nurse Practitioner
Phone
(773) 423-6178

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 209.014576 IL Primary

Addresses

Primary practice location

2412 W Fullerton Ave
Chicago, IL 60647-7435

Mailing address

2412 W Fullerton Ave
Chicago, IL 60647-7435
Phone (773) 384-7977

Other names 1

  • Olivo Wellness Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Olivo Medical Wellness Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1558812362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2412 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606477435",
            "telephone_number": "773-384-7977",
            "fax_number": "773-451-8285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606477435",
            "telephone_number": "773-384-7977",
            "fax_number": "773-451-8285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRU SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A",
        "authorized_official_last_name": "DE SANTIAGO",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "773-423-6178",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "209.014576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olivo Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 17, 2016; 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.