Provider Demographics
NPI:1083638522
Name:VILLALOBOS, RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
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 1:100B ALTON GLOOR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526
Mailing Address - Country:US
Mailing Address - Phone:956-350-2660
Mailing Address - Fax:956-350-0505
Practice Address - Street 1:2121 PEASE ST
Practice Address - Street 2:STE 207
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8327
Practice Address - Country:US
Practice Address - Phone:956-350-2660
Practice Address - Fax:956-350-0505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK99272080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179134501Medicaid