Provider Demographics
NPI:1245301316
Name:SANTIBANEZ, DANIEL JESUS (MPH, RD, LDN)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JESUS
Last Name:SANTIBANEZ
Suffix:
Gender:M
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 OCEAN BLVD
Mailing Address - Street 2:#96
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-5458
Mailing Address - Country:US
Mailing Address - Phone:904-318-7477
Mailing Address - Fax:
Practice Address - Street 1:3100 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 220
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2758
Practice Address - Country:US
Practice Address - Phone:904-724-2043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4786133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered