Provider Demographics
NPI:1194019216
Name:VILLALOBOS, LUIS ROBERTO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ROBERTO
Last Name:VILLALOBOS
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 1:6119 KRISTEN PARK LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4024
Mailing Address - Country:US
Mailing Address - Phone:713-253-5432
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 1810
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8238
Practice Address - Country:US
Practice Address - Phone:713-757-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05-110246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant