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General NPI Number Information
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NPI Number | 1942793849
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Entity Type | Individual
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Provider Name | LYDIA E URDIALES RDN
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Gender | Female
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 4108 W FLETCHER ST
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City | CHICAGO
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State | IL
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Zip | 60641-5431
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Country | US
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Telephone | 513-545-0537
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Fax |
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Provider Business Mailing Address
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Address Line | 3012 N KNOX AVE
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City | CHICAGO
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State | IL
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Zip | 60641-5203
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Country | US
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Telephone | 872-588-7516
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164.006832
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License Number State | IL
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