Provider Demographics
NPI:1629336771
Name:SANTIAGO GORDIAN, MONICA (RDN, LND)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:SANTIAGO GORDIAN
Suffix:
Gender:F
Credentials:RDN, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17166 GOOSEN DR
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-4508
Mailing Address - Country:US
Mailing Address - Phone:787-550-2510
Mailing Address - Fax:
Practice Address - Street 1:CALLE GARCIA DE LA NOCEDA B26
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-550-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1532133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered