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Johan W Sosa De La Cruz, MD
Student in an Organized Health Care Education/Training Program in Peoria, Illinois
NPI 1992408215

Johan W Sosa De La Cruz is a Student in an Organized Health Care Education/Training Program based in Peoria, IL. Johan W Sosa De La Cruz practices in Peoria, IL and has the professional credentials of MD. The NPI Number for Johan W Sosa De La Cruz is 1992408215 and holds a License No. 90200000X (Illinois).

The current practice location address for Johan W Sosa De La Cruz is 530 Ne Glen Oak Ave, Peoria, IL and can be reached out via phone at 309-655-2702.

Location: 530 Ne Glen Oak Ave, Peoria, IL, 61637-0001
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1992408215
Provider Name
Johan W Sosa De La Cruz
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
530 Ne Glen Oak Ave, Peoria, IL, 61637-0001
Phone Number
309-655-2702
Fax Number
Provider Enumeration Date
03/24/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
530 Ne Glen Oak Ave
City
Peoria
State
Illinois
Zip
61637-0001
Phone Number
309-655-2702
Fax Number
person
Provider Business Mailing Address Details
Address
530 Ne Glen Oak Ave
City
Peoria
State
Illinois
Zip
61637-0001
Phone Number
309-655-2702
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
90200000X (Illinois)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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