Healthcare Provider Details

I. General information

NPI: 1407763097
Provider Name (Legal Business Name): DIANA SANTA MARIA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 S OCEAN DR APT 201
HALLANDALE BEACH FL
33009-7224
US

IV. Provider business mailing address

3181 S OCEAN DR APT 201
HALLANDALE BEACH FL
33009-7224
US

V. Phone/Fax

Practice location:
  • Phone: 786-877-7745
  • Fax:
Mailing address:
  • Phone: 786-877-7745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberND8178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: