Provider Demographics
NPI:1760987804
Name:YBARRA LOPEZ, MARIA ANTONIA (RD, RDN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANTONIA
Last Name:YBARRA LOPEZ
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 E HACKBERRY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5737
Mailing Address - Country:US
Mailing Address - Phone:956-688-3700
Mailing Address - Fax:956-618-3718
Practice Address - Street 1:901 JAMES ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6619
Practice Address - Country:US
Practice Address - Phone:956-973-2655
Practice Address - Fax:956-968-6631
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX707683133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered