Provider Demographics
NPI:1114960291
Name:VILLALOVAS, RANDAL E (MD)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:E
Last Name:VILLALOVAS
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 1:550 W HWY 50
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2238
Mailing Address - Country:US
Mailing Address - Phone:719-530-2048
Mailing Address - Fax:719-530-2055
Practice Address - Street 1:1000 RUSH DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9627
Practice Address - Country:US
Practice Address - Phone:719-530-2048
Practice Address - Fax:719-530-2055
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60546207R00000X, 208M00000X
TXN4182207R00000X
CO52599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A605460Medicaid
TX2156879-01Medicaid
TX215687902Medicaid
TX215687903Medicaid
TXTXB155533Medicare PIN
CA00A605460Medicare ID - Type Unspecified
CA00A605460Medicaid
TXTXB128149Medicare PIN
TX2156879-01Medicaid
TXTXB107445Medicare PIN
TX215687902Medicaid
TXP00941021Medicare PIN