Provider Demographics
NPI:1497570717
Name:ROMANACH-SANTIAGO, DIANA (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ROMANACH-SANTIAGO
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 W MAIN ST APT 301
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3584
Mailing Address - Country:US
Mailing Address - Phone:513-291-6056
Mailing Address - Fax:
Practice Address - Street 1:2424 21ST AVE S
Practice Address - Street 2:#201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-861-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4254133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered