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NPI Code Detail

MEDICARE: MR. JOSEPH JAMIE IBARRA MCN, RDN, LD

MEDICARE: MR. JOSEPH JAMIE IBARRA MCN, RDN, LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian86146437TX

General Provider Information

NPI Number : 1003381286
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSEPH JAMIE IBARRA MCN, RDN, LD
Provider Business Mailing Address
First Line : 2528 MARINA DR
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75054-6851
Country : US
Telephone Number : 909-636-1340
Fax Number :
Provider Business Practice Location Address
First Line : 2800 SHORELINE DR STE 120
Second Line :
City : DENTON
State : TX
Zip : 76210-0130
Country : US
Telephone Number : 909-636-1340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2018
Last Update Date : 02/06/2026

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