Provider Demographics
NPI:1174922868
Name:IGLESIAS, ROSA V (RD)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:V
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S MATTIE M KELLY BLVD APT 1107
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3259
Mailing Address - Country:US
Mailing Address - Phone:575-805-5154
Mailing Address - Fax:
Practice Address - Street 1:160 S MATTIE M KELLY BLVD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-3257
Practice Address - Country:US
Practice Address - Phone:575-805-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12022133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered