Provider Demographics
NPI:1093437550
Name:AYALA, GRISELDA (RD)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:AYALA
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 1:3657 N PINE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4503
Mailing Address - Country:US
Mailing Address - Phone:773-477-3664
Mailing Address - Fax:312-648-0155
Practice Address - Street 1:3657 N PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4503
Practice Address - Country:US
Practice Address - Phone:773-477-3664
Practice Address - Fax:312-648-0155
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered