MEDICARE: RITA VARGAS RD, LDN, CDCES

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	164004375	IL

General Provider Information

NPI Number	:	1942431978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA VARGAS RD, LDN, CDCES

Provider Business Mailing Address
First Line	:	1351 SYCAMORE LN
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-1453
Country	:	US
Telephone Number	:	630-202-5137
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 SYCAMORE LN
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-1453
Country	:	US
Telephone Number	:	630-202-5137
Fax Number	:

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

Provider Enumeration Date	:	08/08/2009
Last Update Date	:	08/20/2020

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