Provider Demographics
NPI:1265862015
Name:VILLALOBOS, JEMIMA
Entity Type:Individual
Prefix:
First Name:JEMIMA
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEMIMA
Other - Middle Name:
Other - Last Name:ESTRADA MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2117
Mailing Address - Country:US
Mailing Address - Phone:209-464-4524
Mailing Address - Fax:209-464-2272
Practice Address - Street 1:540 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2117
Practice Address - Country:US
Practice Address - Phone:209-464-4524
Practice Address - Fax:209-464-2272
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker