Healthcare Provider Details

I. General information

NPI: 1386419380
Provider Name (Legal Business Name): EVELYN RIOS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 W 79TH ST
CHICAGO IL
60620-2699
US

IV. Provider business mailing address

24325 S VALLEY DR
CHANNAHON IL
60410-5229
US

V. Phone/Fax

Practice location:
  • Phone: 815-582-0413
  • Fax:
Mailing address:
  • Phone: 815-582-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164009601
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number164009601
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: