Provider Demographics
NPI:1508665076
Name:ORTIZ SANTIAGO, THANIA NICOLE (RDN, LD)
Entity type:Individual
Prefix:
First Name:THANIA
Middle Name:NICOLE
Last Name:ORTIZ SANTIAGO
Suffix:
Gender:
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 ROSWELL RD UNIT 203
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1208
Mailing Address - Country:US
Mailing Address - Phone:787-212-6992
Mailing Address - Fax:
Practice Address - Street 1:5641 ROSWELL RD UNIT 203
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-1208
Practice Address - Country:US
Practice Address - Phone:787-212-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.10672133V00000X
GALD007277133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered