Provider Demographics
NPI:1093884678
Name:GIRALDO, ANITA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:GIRALDO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:2900 N LAKE SHORE DR
Mailing Address - Street 2:SAINT JOSEPH HOSPITAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5640
Mailing Address - Country:US
Mailing Address - Phone:773-665-3069
Mailing Address - Fax:773-665-6231
Practice Address - Street 1:2900 N LAKE SHORE DR
Practice Address - Street 2:SAINT JOSEPH HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5640
Practice Address - Country:US
Practice Address - Phone:773-665-3069
Practice Address - Fax:773-665-6231
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
L91718Medicare ID - Type UnspecifiedMEMBER #