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NPI Code Detail

MEDICARE: MS. CRISTAL MEDINA MS, RDN, LDN

MEDICARE: MS. CRISTAL MEDINA MS, RDN, 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 Dietitian

General Provider Information

NPI Number : 1700423688
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CRISTAL MEDINA MS, RDN, LDN
Provider Business Mailing Address
First Line : 1935 N KEDVALE AVE FL 2
Second Line :
City : CHICAGO
State : IL
Zip : 60639-4927
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3921 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2417
Country : US
Telephone Number : 831-245-6357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2019
Last Update Date : 12/10/2019

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