Jacqueline Alejandra Gaytan Fangonilo

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

240 Shotwell St
San Francisco, CA 94110-1323

Phone

(415) 552-1013

Fax

(415) 552-7040

NPI assigned

Nov 14, 2019

Last updated

Nov 14, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573689600000",
    "number": "1922643865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 ESCANYO DR",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940804134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 SHOTWELL ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941101323",
            "telephone_number": "415-552-1013",
            "fax_number": "415-552-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANGONILO",
        "first_name": "JACQUELINE",
        "middle_name": "ALEJANDRA GAYTAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-14",
        "last_updated": "2019-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacquelinegaytan@mnhc.org",
            "affiliation": "N",
            "endpointDescription": "work email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "240 Shotwell St",
            "city": "San Francisco",
            "state": "CA",
            "country_code": "US",
            "postal_code": "941101323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Margaret C. Fang, MD
• Stacy Fang, M.D.
• Wenzheng Fang
• Zhi Fang
• John J Fangman, MD
• Charles Fann
• Amanda Marie Fanniff, PHD
• Laura E Fannon, PSYD INTERN
• Lewis Dale Fannon, RN, NP
• Kelessery Yah Fanny, PHARMD

• Registered Dietitian in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.