Provider Demographics
NPI:1558975599
Name:CARUSO, BELEN OLMO
Entity Type:Individual
Prefix:
First Name:BELEN
Middle Name:OLMO
Last Name:CARUSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 S VOLUSIA AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-9135
Mailing Address - Country:US
Mailing Address - Phone:386-774-0101
Mailing Address - Fax:386-774-0249
Practice Address - Street 1:2575 S VOLUSIA AVE STE 400
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9135
Practice Address - Country:US
Practice Address - Phone:376-774-0101
Practice Address - Fax:386-774-0249
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2680133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal