Provider Demographics
NPI:1023361870
Name:MACHUTTA-VILLALOBOS, BRIGETTE MARIE
Entity Type:Individual
Prefix:MS
First Name:BRIGETTE
Middle Name:MARIE
Last Name:MACHUTTA-VILLALOBOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 LAKESIDE CT STE 101
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4862
Mailing Address - Country:US
Mailing Address - Phone:775-786-6880
Mailing Address - Fax:
Practice Address - Street 1:3500 LAKESIDE CT STE 101
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4862
Practice Address - Country:US
Practice Address - Phone:775-786-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner