Provider Demographics
NPI:1467101733
Name:VILLALOBOS, SARAH I
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:I
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LUCA
Other - Middle Name:A
Other - Last Name:VILLALOBOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1831 E GROVECENTER ST APT 16
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1128
Mailing Address - Country:US
Mailing Address - Phone:626-254-3798
Mailing Address - Fax:
Practice Address - Street 1:1831 E GROVECENTER ST APT 16
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1128
Practice Address - Country:US
Practice Address - Phone:626-254-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty