Provider Demographics
NPI:1043469554
Name:ESPERA, MARIA CRISTINA VILLASENOR
Entity type:Individual
Prefix:MRS
First Name:MARIA CRISTINA
Middle Name:VILLASENOR
Last Name:ESPERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 COLUMBINE CIR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4978
Mailing Address - Country:US
Mailing Address - Phone:815-685-7684
Mailing Address - Fax:
Practice Address - Street 1:1525 W HOMER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-1280
Practice Address - Country:US
Practice Address - Phone:888-785-7370
Practice Address - Fax:888-785-7380
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.002897133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL836195OtherCOMMISSION ON DIETETIC REGISTRATION
ILP00705063OtherMEDICARE RAILROAD CARRIER
IL206082003Medicare PIN