Provider Demographics
NPI:1104579754
Name:SANTIAGO ESTRADA, JULIA Y
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:Y
Last Name:SANTIAGO ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 AVE TITO CASTRO STE 606
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4721
Mailing Address - Country:US
Mailing Address - Phone:787-987-8132
Mailing Address - Fax:787-842-3118
Practice Address - Street 1:909 AVE TITO CASTRO STE 606
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4721
Practice Address - Country:US
Practice Address - Phone:787-651-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1469133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist