Provider Demographics
NPI:1083373682
Name:SANTOS, CHRISTINE ELYSE (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELYSE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7344 E DEER VALLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7456
Mailing Address - Country:US
Mailing Address - Phone:480-751-2205
Mailing Address - Fax:
Practice Address - Street 1:7344 E DEER VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7456
Practice Address - Country:US
Practice Address - Phone:480-751-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ38-4088946Medicaid