Provider Demographics
NPI:1669254447
Name:ESPARZA, CHRISTIAN (RD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 N ARMOUR ST # 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6192
Mailing Address - Country:US
Mailing Address - Phone:210-248-6691
Mailing Address - Fax:
Practice Address - Street 1:524 N ARMOUR ST # 2W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-6192
Practice Address - Country:US
Practice Address - Phone:210-248-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86133177133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered