Provider Demographics
NPI:1871716738
Name:ALTEZ, CARLOS CESAR (PA)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:CESAR
Last Name:ALTEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-5107
Mailing Address - Country:US
Mailing Address - Phone:773-869-7488
Mailing Address - Fax:773-869-3578
Practice Address - Street 1:2800 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-5107
Practice Address - Country:US
Practice Address - Phone:773-869-7488
Practice Address - Fax:773-869-3578
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-000494363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant