Provider Demographics
NPI:1619308608
Name:ROBLES, RAQUEL (RDN, LDN)
Entity type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:
Last Name:ROBLES
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 BENTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-1963
Mailing Address - Country:US
Mailing Address - Phone:708-691-2382
Mailing Address - Fax:224-220-5064
Practice Address - Street 1:6200 BENTLEY AVE
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-1963
Practice Address - Country:US
Practice Address - Phone:708-691-2382
Practice Address - Fax:224-220-5064
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005838133NN1002X, 133V00000X, 133VN1005X, 133VN1004X, 133VN1006X, 133VN1101X, 133VN1201X, 133VN1301X, 133VN1501X, 133N00000X
MO2024034004133V00000X
133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, GerontologicalGroup - Multi-Specialty
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty