Provider Demographics
NPI:1841770252
Name:GIMENEZ, ANA LAURA (RDN, CDCES)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:LAURA
Last Name:GIMENEZ
Suffix:
Gender:F
Credentials:RDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 KEARNEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3228
Mailing Address - Country:US
Mailing Address - Phone:908-977-7270
Mailing Address - Fax:
Practice Address - Street 1:1029 KEARNEY DR
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3228
Practice Address - Country:US
Practice Address - Phone:908-977-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86079989133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered