Provider Demographics
NPI:1063998573
Name:SANTANA, NAEIMA (RD)
Entity type:Individual
Prefix:
First Name:NAEIMA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NAEIMA
Other - Middle Name:
Other - Last Name:JAFARIAN NASERIZAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:24060 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6801
Practice Address - Country:US
Practice Address - Phone:425-690-3522
Practice Address - Fax:425-690-9522
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2112868Medicaid