Provider Demographics
NPI:1922631316
Name:GIL, ALTAIRA (BS)
Entity Type:Individual
Prefix:
First Name:ALTAIRA
Middle Name:
Last Name:GIL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:ALTAIRA
Other - Middle Name:
Other - Last Name:GIL-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3824 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4206
Mailing Address - Country:US
Mailing Address - Phone:773-937-3076
Mailing Address - Fax:
Practice Address - Street 1:3824 W 69TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4206
Practice Address - Country:US
Practice Address - Phone:773-937-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered