Individual
JERROD PAUL LIBONATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
280 S DECATUR BLVD, LAS VEGAS, NV 89107-2936
(702) 759-0953
Mailing address
280 S DECATUR BLVD, LAS VEGAS, NV 89107-2936
(702) 759-0953
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
39960-DI-0
NV
133V00000X
Registered Dietitian
911745
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39960-DI-0
—
NV
05
—
911745
—
CA
Enumeration date
04/20/2021
Last updated
05/15/2021
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