Individual
MRS. IDA MARIE IBARRA RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2692 BRADEN WAY, LEXINGTON, KY 40509-8571
(787) 922-2177
Mailing address
2692 BRADEN WAY, LEXINGTON, KY 40509-8571
(787) 922-2177
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
240942
KY
Other
Enumeration date
05/10/2019
Last updated
05/10/2019
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