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NPI Code Detail

MEDICARE: GUSTAVO SALGADO RD, LDN

MEDICARE: GUSTAVO SALGADO RD, LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian164009296IL

General Provider Information

NPI Number : 1306625306
Entity Type Code : Individual
Provider Name (Legal Business Name) : GUSTAVO SALGADO RD, LDN
Provider Business Mailing Address
First Line : 729 2ND AVE
Second Line :
City : AURORA
State : IL
Zip : 60505-4447
Country : US
Telephone Number : 331-457-3797
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S FAIRFIELD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1782
Country : US
Telephone Number : 331-457-3797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2023
Last Update Date : 03/11/2026

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