Provider Demographics
NPI:1316210925
Name:VILLALOBOS, IDANIA (MEDICAL ASST)
Entity Type:Individual
Prefix:
First Name:IDANIA
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:MEDICAL ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 NW 186TH ST APT B501
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8340
Mailing Address - Country:US
Mailing Address - Phone:786-368-3213
Mailing Address - Fax:
Practice Address - Street 1:9160 NW 122ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-1730
Practice Address - Country:US
Practice Address - Phone:305-828-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206309363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical