Provider Demographics
NPI:1336458918
Name:SANTANA, JENNIFER MICHELLE (DIETITAN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:SANTANA
Suffix:
Gender:F
Credentials:DIETITAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:M8 CALLE LIRIOS
Mailing Address - Street 2:JARDINES DE BORINQUEN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4227
Mailing Address - Country:US
Mailing Address - Phone:787-439-4692
Mailing Address - Fax:
Practice Address - Street 1:1715 AVE PONCE DE LEON
Practice Address - Street 2:NUTRITION DEPT.
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1958
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1468133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1468OtherDIETITIAN'S LICENSE