Individual
IVON CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
3910 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7596
(208) 523-1122
(208) 523-2582
Mailing address
3910 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7596
(208) 523-1122
(208) 523-2582
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
ID
Other
Enumeration date
05/30/2019
Last updated
05/30/2019
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