Provider Demographics
NPI:1346953957
Name:LONDOS, MARIA (MS RD CDCES)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:LONDOS
Suffix:
Gender:F
Credentials:MS RD CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 PAMELA LN APT 9
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1860
Mailing Address - Country:US
Mailing Address - Phone:708-717-2971
Mailing Address - Fax:708-423-5732
Practice Address - Street 1:1890 SILVER CROSS BLVD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9524
Practice Address - Country:US
Practice Address - Phone:815-300-7782
Practice Address - Fax:815-300-4298
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164-003386133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered