Healthcare Provider Details

I. General information

NPI: 1023933033
Provider Name (Legal Business Name): ABIGAIL FAITH BENNETT RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6285 E SPRING ST # 284
LONG BEACH CA
90808-4020
US

IV. Provider business mailing address

443 PINELLAS BAYWAY S APT 105
ST PETERSBURG FL
33715-1961
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-4055
  • Fax:
Mailing address:
  • Phone: 850-419-8233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: