Provider Demographics
NPI:1235456286
Name:VILLALOBOS, GLORIA L
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:L
Last Name: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 1:1100 W STATE ROAD 84
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-2436
Mailing Address - Country:US
Mailing Address - Phone:954-765-0550
Mailing Address - Fax:954-765-0587
Practice Address - Street 1:1100 W STATE ROAD 84
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2436
Practice Address - Country:US
Practice Address - Phone:954-765-0550
Practice Address - Fax:954-765-0587
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator