Healthcare Provider Details

I. General information

NPI: 1609740018
Provider Name (Legal Business Name): ABIGAIL JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 SHOTWELL ST
SAN FRANCISCO CA
94110-1323
US

IV. Provider business mailing address

240 SHOTWELL ST
SAN FRANCISCO CA
94110-1323
US

V. Phone/Fax

Practice location:
  • Phone: 415-552-3870
  • Fax:
Mailing address:
  • Phone: 415-552-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86415285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: