Healthcare Provider Details

I. General information

NPI: 1285270207
Provider Name (Legal Business Name): RUBY BAGGAN RD, IFNCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 CANADA GOOSE DR
LOVELAND CO
80537-6556
US

IV. Provider business mailing address

2519 S SHIELDS ST STE 1K
FORT COLLINS CO
80526-1855
US

V. Phone/Fax

Practice location:
  • Phone: 970-305-5180
  • Fax:
Mailing address:
  • Phone: 970-829-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86083713
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: