Provider Demographics
NPI:1326513391
Name:BOUSABA, CAYLA JABLONSKI (RDN)
Entity Type:Individual
Prefix:
First Name:CAYLA
Middle Name:JABLONSKI
Last Name:BOUSABA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LIBBIE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2664
Mailing Address - Country:US
Mailing Address - Phone:828-443-5789
Mailing Address - Fax:
Practice Address - Street 1:420 LIBBIE AVE STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2664
Practice Address - Country:US
Practice Address - Phone:828-443-5789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86087622133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered