Provider Demographics
NPI:1679374474
Name:GONZALES, JIMENA L (RDN)
Entity type:Individual
Prefix:
First Name:JIMENA
Middle Name:L
Last Name:GONZALES
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3F BRYNWOOD GDNS APT 34
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2349
Mailing Address - Country:US
Mailing Address - Phone:908-708-7211
Mailing Address - Fax:
Practice Address - Street 1:3F BRYNWOOD GDNS APT 34
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2349
Practice Address - Country:US
Practice Address - Phone:908-708-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86370738133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered