Provider Demographics
NPI:1306900899
Name:IBARRA, GUILLERMINA (RD, LD)
Entity type:Individual
Prefix:MS
First Name:GUILLERMINA
Middle Name:
Last Name:IBARRA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 6 BOX 100-15
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-9518
Mailing Address - Country:US
Mailing Address - Phone:956-584-9802
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 100-15
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-9518
Practice Address - Country:US
Practice Address - Phone:956-584-9802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07240133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered