1740561703 NPI number — MS. LETICIA SANTOS AJODAH RD

Table of content: MS. LETICIA SANTOS AJODAH RD (NPI 1740561703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740561703 NPI number — MS. LETICIA SANTOS AJODAH RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AJODAH
Provider First Name:
LETICIA
Provider Middle Name:
SANTOS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740561703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20720 48TH AVE
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
OAKLAND GARDENS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11364-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-279-3423
Provider Business Mailing Address Fax Number:
718-279-3423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20720 48TH AVE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
OAKLAND GARDENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11364-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-279-3423
Provider Business Practice Location Address Fax Number:
718-279-3423
Provider Enumeration Date:
09/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X , with the licence number:  003396-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 371029 . This is a "REGISTERED DIETITAN NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 003396-1 . This is a "CERTIFIED DIETITIAN-NUTRITIONIST LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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