Provider Demographics
NPI:1013596501
Name:VILLATORO, LUIS ALONSO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALONSO
Last Name:VILLATORO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5048 CALLE ESPANA NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1863
Mailing Address - Country:US
Mailing Address - Phone:505-721-0941
Mailing Address - Fax:
Practice Address - Street 1:5048 CALLE ESPANA NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1863
Practice Address - Country:US
Practice Address - Phone:505-721-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1837622471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography