Vanessa Alicea Matos, R.D.
Individual provider Active NPI Registered Dietitian · Chicago, IL
NPI 1003104860 · NPPES record last updated Apr 3, 2024
Key facts
- NPI
- 1003104860
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 164005257 (IL)
- Practice address
- 2003 W Fulton St
Suite 105
Chicago, IL 60612-2345 - Phone
- (312) 850-3438
- Fax
- (312) 638-9872
- NPI assigned
- Jul 14, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164005257 | IL | Yes |
Addresses
Primary practice location
2003 W Fulton St
Suite 105
Chicago, IL 60612-2345
Mailing address
2003 W Fulton St
Suite 105
Chicago, IL 60612-2345
Phone (312) 850-3438
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164005257 | Other | IL | LICENSE |
Other names
- Vanessa Alicea
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All providers in Chicago, IL · Registered Dietitian in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.