Healthcare Provider Details

I. General information

NPI: 1881122232
Provider Name (Legal Business Name): ANGELA PERIZES RD,LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 S MAY ST # 1F
CHICAGO IL
60608-3359
US

IV. Provider business mailing address

1943 S MAY ST # 1F
CHICAGO IL
60608-3359
US

V. Phone/Fax

Practice location:
  • Phone: 312-549-8866
  • Fax: 312-549-8861
Mailing address:
  • Phone: 312-549-8866
  • Fax: 312-549-8861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164007092
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: