Healthcare Provider Details
I. General information
NPI: 1619308608
Provider Name (Legal Business Name): RAQUEL ROBLES RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 12/02/2013
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6200 BENTLEY AVE
WILLOWBROOK IL
60527-1963
US
IV. Provider business mailing address
6200 BENTLEY AVE
WILLOWBROOK IL
60527-1963
US
V. Phone/Fax
- Phone: 708-691-2382
- Fax: 224-220-5064
- Phone: 708-691-2382
- Fax: 224-220-5064
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133NN1002X |
| Taxonomy | Nutrition Education Nutritionist |
| License Number | 164.005838 |
| License Number State | IL |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133V00000X |
| Taxonomy | Registered Dietitian |
| License Number | 164.005838 |
| License Number State | IL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133V00000X |
| Taxonomy | Registered Dietitian |
| License Number | 2024034004 |
| License Number State | MO |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133VN1005X |
| Taxonomy | Renal Nutrition Registered Dietitian |
| License Number | 164.005838 |
| License Number State | IL |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133VN1004X |
| Taxonomy | Pediatric Nutrition Registered Dietitian |
| License Number | 164.005838 |
| License Number State | IL |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133VN1006X |
| Taxonomy | Metabolic Nutrition Registered Dietitian |
| License Number | 164.005838 |
| License Number State | IL |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133VN1101X |
| Taxonomy | Gerontological Nutrition Registered Dietitian |
| License Number | 164.005838 |
| License Number State | IL |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133VN1201X |
| Taxonomy | Obesity and Weight Management Nutrition Registered Dietitian |
| License Number | 164.005838 |
| License Number State | IL |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133VN1301X |
| Taxonomy | Oncology Nutrition Registered Dietitian |
| License Number | 164.005838 |
| License Number State | IL |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133VN1501X |
| Taxonomy | Sports Dietetics Nutrition Registered Dietitian |
| License Number | 164.005838 |
| License Number State | IL |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133N00000X |
| Taxonomy | Nutritionist |
| License Number | 164.005838 |
| License Number State | IL |
| # 12 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 133VN1201X |
| Taxonomy | Obesity and Weight Management Nutrition Registered Dietitian |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
