Healthcare Provider Details

I. General information

NPI: 1083373682
Provider Name (Legal Business Name): CHRISTINE ELYSE SANTOS NUTRITIONIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7344 E DEER VALLEY RD STE 100
SCOTTSDALE AZ
85255-7456
US

IV. Provider business mailing address

7344 E DEER VALLEY RD STE 100
SCOTTSDALE AZ
85255-7456
US

V. Phone/Fax

Practice location:
  • Phone: 480-751-2205
  • Fax:
Mailing address:
  • Phone: 480-751-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: