MEDICARE: MR. DANIEL JESUS SANTIBANEZ MPH, RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND4786	FL

General Provider Information

NPI Number	:	1245301316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL JESUS SANTIBANEZ MPH, RD, LDN

Provider Business Mailing Address
First Line	:	901 OCEAN BLVD
Second Line	:	#96
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-5458
Country	:	US
Telephone Number	:	904-318-7477
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 UNIVERSITY BLVD S
Second Line	:	SUITE 220
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2758
Country	:	US
Telephone Number	:	904-724-2043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	02/24/2009

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