Healthcare Provider Details

I. General information

NPI: 1144689894
Provider Name (Legal Business Name): CHRISTINA GAMBONEY MBA, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 W FULTON ST STE 300
CHICAGO IL
60612-2345
US

IV. Provider business mailing address

118 PARK AVE
RIVER FOREST IL
60305-2040
US

V. Phone/Fax

Practice location:
  • Phone: 312-850-3438
  • Fax:
Mailing address:
  • Phone: 708-903-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.006688
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: