Provider Demographics
NPI:1508686023
Name:OLDHAM, ISABELLA KATHERINE (RDN, LDN)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:KATHERINE
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19501 SIERRA MIA RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3818
Mailing Address - Country:US
Mailing Address - Phone:949-648-0103
Mailing Address - Fax:
Practice Address - Street 1:19501 SIERRA MIA RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-3818
Practice Address - Country:US
Practice Address - Phone:949-648-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86198144133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered