Provider Demographics
NPI:1063866721
Name:FERNANDEZ GIL, IRENE (RDN LDN)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:FERNANDEZ GIL
Suffix:
Gender:F
Credentials:RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3946
Mailing Address - Country:US
Mailing Address - Phone:312-560-9304
Mailing Address - Fax:
Practice Address - Street 1:1943 S MAY ST # 1F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3359
Practice Address - Country:US
Practice Address - Phone:312-549-8866
Practice Address - Fax:312-549-8861
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164006180Medicaid