Provider Demographics
NPI:1942431978
Name:VARGAS, RITA (RD, LDN, CDCES)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:RD, LDN, CDCES
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:FAMERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-1453
Mailing Address - Country:US
Mailing Address - Phone:630-202-5137
Mailing Address - Fax:
Practice Address - Street 1:1351 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-1453
Practice Address - Country:US
Practice Address - Phone:630-202-5137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-08
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004375133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered