Provider Demographics
NPI:1437217007
Name:VILLALOBOS, LILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:LILLIAM
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2904
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:5030 W MCDOWELL RD STE 16
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-3947
Practice Address - Country:US
Practice Address - Phone:602-278-1414
Practice Address - Fax:602-269-8410
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ320402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ894247Medicaid
AZH34099Medicare UPIN
AZ894247Medicaid