Provider Demographics
NPI:1316318108
Name:YBORRA, MARA (RD, LRD)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:YBORRA
Suffix:
Gender:F
Credentials:RD, LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7565
Mailing Address - Country:US
Mailing Address - Phone:701-221-1435
Mailing Address - Fax:
Practice Address - Street 1:3315 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7565
Practice Address - Country:US
Practice Address - Phone:701-221-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND86076856133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered