Healthcare Provider Details

I. General information

NPI: 1881422632
Provider Name (Legal Business Name): XIMENA HERNANDEZ GONZALEZ RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
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 Number86434633
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: