Healthcare Provider Details

I. General information

NPI: 1104707660
Provider Name (Legal Business Name): FUELED BY XIME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14305 271ST PL NE
DUVALL WA
98019-8657
US

IV. Provider business mailing address

14305 271ST PL NE
DUVALL WA
98019-8657
US

V. Phone/Fax

Practice location:
  • Phone: 425-449-9729
  • Fax:
Mailing address:
  • Phone: 425-449-9729
  • 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: XIMENA HERNANDEZ GONZALEZ
Title or Position: OWNER
Credential: RDN
Phone: 425-449-9729