Provider Demographics
NPI:1952194300
Name:GONZAGA PICKEL, CINTIA (RDN)
Entity type:Individual
Prefix:
First Name:CINTIA
Middle Name:
Last Name:GONZAGA PICKEL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 GREEN BAY RD STE 355
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2412
Mailing Address - Country:US
Mailing Address - Phone:773-575-5740
Mailing Address - Fax:
Practice Address - Street 1:2070 GREEN BAY RD STE 355
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2412
Practice Address - Country:US
Practice Address - Phone:773-575-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164012119133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered