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General NPI Number Information
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NPI Number | 1376157479
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Entity Type | Individual
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Provider Name | ADRIANA BUENO NDTR
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 225 E CHICAGO AVE # 59
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-227-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 4220 S CHAMPLAIN AVE APT 2N
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City | CHICAGO
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State | IL
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Zip | 60653-2951
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Country | US
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Telephone | 815-545-7317
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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 | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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License Number | 86052267
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License Number State | IL
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