Provider Demographics
NPI:1417191636
Name:MANSFIELD PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:MANSFIELD PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-756-1125
Mailing Address - Street 1:370 CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1057
Mailing Address - Country:US
Mailing Address - Phone:419-756-1125
Mailing Address - Fax:419-756-1825
Practice Address - Street 1:370 CLINE AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1057
Practice Address - Country:US
Practice Address - Phone:419-756-1125
Practice Address - Fax:419-756-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005536261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty