Provider Demographics
NPI:1902151590
Name:IBARRA, ANAYANCI (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ANAYANCI
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 1:4408 QUINCE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-3637
Mailing Address - Country:US
Mailing Address - Phone:956-467-6884
Mailing Address - Fax:
Practice Address - Street 1:4408 QUINCE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3637
Practice Address - Country:US
Practice Address - Phone:956-467-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06468133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered