Healthcare Provider Details

I. General information

NPI: 1336577634
Provider Name (Legal Business Name): VANESSA RIGGIO RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 W SCHILLER ST APT 1601
CHICAGO IL
60610-2041
US

IV. Provider business mailing address

500 W FULLERTON PKWY APT 110
CHICAGO IL
60614-5968
US

V. Phone/Fax

Practice location:
  • Phone: 312-878-8800
  • Fax:
Mailing address:
  • Phone: 734-748-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164005992
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: