Healthcare Provider Details

I. General information

NPI: 1104224237
Provider Name (Legal Business Name): DENISE SANTOS RDN, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 LIMITED LN NW STE B
OLYMPIA WA
98502-2638
US

IV. Provider business mailing address

1816 JONQUIL LN NW
OLYMPIA WA
98502-8331
US

V. Phone/Fax

Practice location:
  • Phone: 360-709-0700
  • Fax: 360-709-0703
Mailing address:
  • Phone: 360-609-5998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001948
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: