Individual provider Active NPI

Daniel Jesus Santibanez, MPH, RD, LDN

  • Registered Dietitian
  • Jacksonville, FL
National Provider Identifier
1245301316
Registry record updated Feb 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
ND4786 Issued in FL
Practice address
3100 University Blvd S
Suite 220
Jacksonville, FL 32216-2758
Phone
(904) 724-2043
NPI assigned
Nov 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X ND4786 FL Primary

Addresses

Primary practice location

3100 University Blvd S
Suite 220
Jacksonville, FL 32216-2758

Mailing address

901 Ocean Blvd
#96
Atlantic Beach, FL 32233-5458
Phone (904) 318-7477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ND4786FLMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Nutrition Therapy of Florida, Inc. Dietitian, Registered Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235433600000",
    "number": "1245301316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 OCEAN BLVD",
            "address_2": "#96",
            "city": "ATLANTIC BEACH",
            "state": "FL",
            "postal_code": "322335458",
            "telephone_number": "904-318-7477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 UNIVERSITY BLVD S",
            "address_2": "SUITE 220",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162758",
            "telephone_number": "904-724-2043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTIBANEZ",
        "first_name": "DANIEL",
        "middle_name": "JESUS",
        "name_prefix": "Mr.",
        "credential": "MPH, RD, LDN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-12",
        "last_updated": "2009-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND4786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.