Provider Demographics
NPI:1306625306
Name:SALGADO, GUSTAVO (RD, LDN)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:SALGADO
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4447
Mailing Address - Country:US
Mailing Address - Phone:331-457-3797
Mailing Address - Fax:
Practice Address - Street 1:729 2ND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4447
Practice Address - Country:US
Practice Address - Phone:331-457-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164009296133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered