Provider Demographics
NPI:1164687018
Name:SANTAGATA, ALICIA MARIE (RD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:SANTAGATA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N SHORE RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1633
Mailing Address - Country:US
Mailing Address - Phone:508-930-7127
Mailing Address - Fax:
Practice Address - Street 1:621 DEXTER ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2603
Practice Address - Country:US
Practice Address - Phone:401-729-0008
Practice Address - Fax:401-729-0010
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2553133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered