Provider Demographics
NPI:1437861135
Name:BALDENEGRO, TRACY (RD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BALDENEGRO
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 1:1000 LAKE ST APT 1610
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1527
Mailing Address - Country:US
Mailing Address - Phone:815-228-5225
Mailing Address - Fax:
Practice Address - Street 1:1000 LAKE ST APT 1610
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1527
Practice Address - Country:US
Practice Address - Phone:815-228-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered