Provider Demographics
NPI:1346294428
Name:VILLALOBOS, XAVIER
Entity Type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:
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:PO BOX 3307
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-3307
Mailing Address - Country:US
Mailing Address - Phone:787-855-1735
Mailing Address - Fax:787-855-1735
Practice Address - Street 1:C1 CALLE 2
Practice Address - Street 2:URB. VILLA REAL
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-3804
Practice Address - Country:US
Practice Address - Phone:787-855-1735
Practice Address - Fax:787-855-1735
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1315247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57712Medicare ID - Type UnspecifiedIDTF