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General NPI Number Information
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NPI Number | 1962623983
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Entity Type | Individual
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Provider Name | CARMEN LYDIA SANTOS SANTOS LND
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | AVENIDA SANTA JUANITA BB-28
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City | BAYAMON
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State | PR
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Zip | 00959
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Country | US
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Telephone | 787-786-8695
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Fax | 787-740-8322
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Provider Business Mailing Address
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Address Line | COLINAS METROPOLITANAS V-19 CALLE MONTE DEL ESTADO
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City | GUAYNABO
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State | PR
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Zip | 00969-5237
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Country | US
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Telephone | 787-790-4564
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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 | 563
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License Number State | PR
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