MEDICARE: CATHERINE J DIAZ MS, RD

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	133V00000X	Registered Dietitian	164.004955	IL

General Provider Information

NPI Number	:	1205068343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE J DIAZ MS, RD

Provider Business Mailing Address
First Line	:	15516 OROGRANDE DR
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 E HURON ST STE 900
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2946
Country	:	US
Telephone Number	:	773-834-2183
Fax Number	:

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

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	08/21/2009

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