Provider Demographics
NPI:1811883317
Name:RANDECKER, ABIGAIL (RD, LD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:RANDECKER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 S FLORES ST APT 2042
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1036
Mailing Address - Country:US
Mailing Address - Phone:832-458-7663
Mailing Address - Fax:
Practice Address - Street 1:326 S FLORES ST APT 2042
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1036
Practice Address - Country:US
Practice Address - Phone:832-458-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86359197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered