Provider Demographics
NPI:1558472209
Name:DIAZ-GRADY, ROBIN (RD, CSR, LDN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:DIAZ-GRADY
Suffix:
Gender:F
Credentials:RD, CSR, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3441
Mailing Address - Country:US
Mailing Address - Phone:815-405-6515
Mailing Address - Fax:815-838-0698
Practice Address - Street 1:3650 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2108
Practice Address - Country:US
Practice Address - Phone:708-422-7715
Practice Address - Fax:708-422-7816
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal