Provider Demographics
NPI:1346976339
Name:MARIN-VILLALOBOS, CLAUDIA GABRIELA
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:GABRIELA
Last Name:MARIN-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 1:330 GARFIELD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2677
Mailing Address - Country:US
Mailing Address - Phone:505-992-0233
Mailing Address - Fax:
Practice Address - Street 1:330 GARFIELD ST STE 202
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2677
Practice Address - Country:US
Practice Address - Phone:505-992-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMPA2024-0020363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program