Provider Demographics
NPI:1265940209
Name:CROUCH, ISABELLE (RDN)
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:
Last Name:CROUCH
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 1:1820 WHITLEY AVE APT 317
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-4232
Mailing Address - Country:US
Mailing Address - Phone:281-468-6949
Mailing Address - Fax:
Practice Address - Street 1:1820 WHITLEY AVE APT 317
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-4232
Practice Address - Country:US
Practice Address - Phone:281-468-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86040685133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered