Individual
VANESSA ALICEA MATOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
2003 W FULTON ST, SUITE 105, CHICAGO, IL 60612-2345
(312) 850-3438
(312) 638-9872
Mailing address
2003 W FULTON ST, SUITE 105, CHICAGO, IL 60612-2345
(312) 850-3438
(312) 638-9872
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164005257
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164005257
LICENSE
IL
Enumeration date
07/14/2011
Last updated
04/03/2024
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