Provider Demographics
NPI:1164203691
Name:SANTOS, CYNTHIA EVELYN (RD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:EVELYN
Last Name:SANTOS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:EVELYN
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 ORO VISTA RD APT 205
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 ORO VISTA RD APT 205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4501
Practice Address - Country:US
Practice Address - Phone:619-940-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
CA86290325133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist