Provider Demographics
NPI:1184029852
Name:ROSTYKUS, ABIGAIL DEJESUS (NP)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:DEJESUS
Last Name:ROSTYKUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:ABIGAIL
Other - Middle Name:MANALUS
Other - Last Name:DEJESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4150 CLEMENT ST
Mailing Address - Street 2:111D
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1545
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:111D
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily