Healthcare Provider Details

I. General information

NPI: 1194504563
Provider Name (Legal Business Name): CRISTINA ARCEO MS RDN LDN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 N LINCOLN AVE
CHICAGO IL
60613-2417
US

IV. Provider business mailing address

3921 N LINCOLN AVE
CHICAGO IL
60613-2417
US

V. Phone/Fax

Practice location:
  • Phone: 312-380-5344
  • Fax: 312-277-0932
Mailing address:
  • Phone: 312-380-5344
  • Fax: 312-277-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-130020
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.005977
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: