Provider Demographics
NPI:1962623983
Name:SANTOS SANTOS, CARMEN LYDIA (LND)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:LYDIA
Last Name:SANTOS SANTOS
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLINAS METROPOLITANAS V-19
Mailing Address - Street 2:CALLE MONTE DEL ESTADO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5237
Mailing Address - Country:US
Mailing Address - Phone:787-790-4564
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA SANTA JUANITA BB-28
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-786-8695
Practice Address - Fax:787-740-8322
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR563133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist