Provider Demographics
NPI:1568085413
Name:ZAVALA, JAIME (RD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:RIZZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:812 N BRAINARD ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:812 N BRAINARD ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3135
Practice Address - Country:US
Practice Address - Phone:708-280-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006315133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered