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General NPI Number Information
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NPI Number | 1750919148
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Entity Type | Individual
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Provider Name | LISBETH STEPHANY SANTIAGO MERCEDES
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Gender | Female
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 5229 WOOD THRUSH WAY
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City | LAKELAND
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State | FL
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Zip | 33811-1877
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Country | US
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Telephone | 787-610-8067
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Fax |
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Provider Business Mailing Address
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Address Line | 5229 WOOD THRUSH WAY
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City | LAKELAND
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State | FL
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Zip | 33811-1877
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Country | US
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Telephone | 787-610-8067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 2124
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 14443
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License Number State | FL
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