Provider Demographics
NPI:1538446547
Name:MOTA, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MOTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6838
Mailing Address - Country:US
Mailing Address - Phone:773-968-1289
Mailing Address - Fax:
Practice Address - Street 1:100 LAKE ST
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-1685
Practice Address - Country:US
Practice Address - Phone:708-344-9885
Practice Address - Fax:708-344-8450
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist