Provider Demographics
NPI:1013730068
Name:VALDEZ, MARISA ESPERANZA (RDN, LDN)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ESPERANZA
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 S KOLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5203
Mailing Address - Country:US
Mailing Address - Phone:773-615-1440
Mailing Address - Fax:
Practice Address - Street 1:6110 S KOLIN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5203
Practice Address - Country:US
Practice Address - Phone:773-615-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008733133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered