MEDICARE: DANIELE ILESA CHASE-ESCALANTE R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1006X	Metabolic Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1093091407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELE ILESA CHASE-ESCALANTE R.D.

Provider Business Mailing Address
First Line	:	2454 TARTARIAN WAY
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4332
Country	:	US
Telephone Number	:	510-303-5199
Fax Number	:

Provider Business Practice Location Address
First Line	:	2454 TARTARIAN WAY
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4332
Country	:	US
Telephone Number	:	510-303-5199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2011
Last Update Date	:	10/30/2011

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