Individual
NORMA PONCE DE LEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., LDN
Contact information
Practice address
10628 W 154TH PL, ORLAND PARK, IL 60462-6035
(773) 895-3214
Mailing address
10628 W 154TH PL, ORLAND PARK, IL 60462-6035
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164005301
IL
133VN1006X
Metabolic Nutrition Registered Dietitian
164005301
IL
Other
Enumeration date
06/28/2015
Last updated
06/28/2015
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