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General NPI Number Information
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NPI Number | 1316355019
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Entity Type | Individual
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Provider Name | MAYA BACH MPH, RDN, LDN
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Gender | Female
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 10 E ONTARIO ST APT 4506
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City | CHICAGO
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State | IL
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Zip | 60611-4784
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Country | US
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Telephone | 916-667-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 10 E ONTARIO ST APT 4506
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City | CHICAGO
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State | IL
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Zip | 60611-4784
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Country | US
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Telephone | 916-667-2020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164.006219
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License Number State | IL
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