Healthcare Provider Details

I. General information

NPI: 1942752001
Provider Name (Legal Business Name): EVELYN IVETTE SANTIAGO DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A26 CALLE FLAMBOYAN
CAGUAS PR
00725-6154
US

IV. Provider business mailing address

M11 CALLE ARECIBO VILLA CARMEN
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-595-3224
  • Fax:
Mailing address:
  • Phone: 787-595-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1892
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: