Provider Demographics
NPI:1376753913
Name:GOMEZ VILLALOBOS, JOSE L (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:GOMEZ VILLALOBOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:L
Other - Last Name:GOMEZ VILLALOBOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 CEDAR ST
Mailing Address - Street 2:TAC-441 SOUTH P.O. BOX 208057
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1612
Mailing Address - Country:US
Mailing Address - Phone:203-785-4198
Mailing Address - Fax:203-737-5453
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-785-4198
Practice Address - Fax:203-737-5453
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045422207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine