MEDICARE: CRISTIAN MENDOZA JARQUIN M.S., 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
1	133V00000X	Registered Dietitian	164.006431	IL

General Provider Information

NPI Number	:	1942693528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTIAN MENDOZA JARQUIN M.S., RDN, LDN

Provider Business Mailing Address
First Line	:	1839 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-8770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 W FULTON ST STE 300
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2345
Country	:	US
Telephone Number	:	773-742-2773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2015
Last Update Date	:	03/26/2015

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