Provider Demographics
NPI:1083232680
Name:ZEPEDA, JESELL (RD)
Entity Type:Individual
Prefix:
First Name:JESELL
Middle Name:
Last Name:ZEPEDA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-2779
Mailing Address - Country:US
Mailing Address - Phone:815-670-4717
Mailing Address - Fax:
Practice Address - Street 1:905 HICKORY RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-2779
Practice Address - Country:US
Practice Address - Phone:815-670-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered