Provider Demographics
NPI:1710495312
Name:ZARLENGO, MIA (RDN)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:ZARLENGO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 N HALSTED ST UNIT CH
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5556
Mailing Address - Country:US
Mailing Address - Phone:815-980-2211
Mailing Address - Fax:
Practice Address - Street 1:770 N LASALLE DR
Practice Address - Street 2:800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654
Practice Address - Country:US
Practice Address - Phone:312-321-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered