Healthcare Provider Details

I. General information

NPI: 1336982990
Provider Name (Legal Business Name): JAN L SANTIAGO TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CALLE MUNOZ RIVERA
GUAYNABO PR
00969-5706
US

IV. Provider business mailing address

URBANIZACION TIBES D34 CALLE AGUEYBANA
PONCE PR
00730
US

V. Phone/Fax

Practice location:
  • Phone: 787-205-1607
  • Fax:
Mailing address:
  • Phone: 787-247-7306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: