Provider Demographics
NPI:1447680004
Name:RESTIVO, RITA MARY (RD,CDE)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:MARY
Last Name:RESTIVO
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9831 S. WESTERN
Mailing Address - Street 2:ADVOCATE MEDICAL GROUP BEVERLY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643
Mailing Address - Country:US
Mailing Address - Phone:773-356-8224
Mailing Address - Fax:
Practice Address - Street 1:9831 S. WESTERN
Practice Address - Street 2:3RD FLOOR ADVOCATE MEDICAL GROUP
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643
Practice Address - Country:US
Practice Address - Phone:773-356-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.000468133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered