Provider Demographics
NPI:1073719084
Name:VILLALOBOS, RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N ORANGE BLOSSOM TR
Mailing Address - Street 2:STE 204
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2307
Mailing Address - Country:US
Mailing Address - Phone:407-944-3097
Mailing Address - Fax:407-944-3098
Practice Address - Street 1:2400 N ORANGE BLOSSOM TR
Practice Address - Street 2:STE 204
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2307
Practice Address - Country:US
Practice Address - Phone:407-944-3097
Practice Address - Fax:407-944-3098
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR164762084N0400X
FLME1241522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology