Healthcare Provider Details

I. General information

NPI: 1669254447
Provider Name (Legal Business Name): CHRISTIAN ESPARZA RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 N WESTERN AVE
CHICAGO IL
60618-2829
US

IV. Provider business mailing address

4234 N WESTERN AVE
CHICAGO IL
60618-2829
US

V. Phone/Fax

Practice location:
  • Phone: 210-248-6691
  • Fax:
Mailing address:
  • Phone: 210-248-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3284
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL007760
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86133177
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5203
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: