Provider Demographics
NPI:1578342424
Name:CAICEDO RUSCA, ISABEL CRISTINA (RDN)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:CRISTINA
Last Name:CAICEDO RUSCA
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 1:3918 VIA POINCIANA STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2991
Mailing Address - Country:US
Mailing Address - Phone:561-969-1261
Mailing Address - Fax:
Practice Address - Street 1:3918 VIA POINCIANA STE 2
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2991
Practice Address - Country:US
Practice Address - Phone:561-969-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12527133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered