Healthcare Provider Details

I. General information

NPI: 1851224265
Provider Name (Legal Business Name): KATHRINA R SANTIAGO MPPD RDN CDM CLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 N FAIR OAKS AVE
PASADENA CA
91103-1801
US

IV. Provider business mailing address

PO BOX 1343
SIMI VALLEY CA
93062-1343
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-9133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number342566
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number86390390
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86390390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: