Healthcare Provider Details

I. General information

NPI: 1538772512
Provider Name (Legal Business Name): GIAVANNA FALBO RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 N WESTERN AVE STE 102
CHICAGO IL
60625-2588
US

IV. Provider business mailing address

5214 N WESTERN AVE STE 102
CHICAGO IL
60625-2588
US

V. Phone/Fax

Practice location:
  • Phone: 872-216-7870
  • Fax:
Mailing address:
  • Phone: 872-216-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.007922
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: