Provider Demographics
NPI:1508946518
Name:VILLALOBOS, RAFAEL (DO)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 BETHEL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2775
Mailing Address - Country:US
Mailing Address - Phone:614-457-7772
Mailing Address - Fax:614-326-2639
Practice Address - Street 1:1151 BETHEL RD STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2775
Practice Address - Country:US
Practice Address - Phone:614-457-7772
Practice Address - Fax:614-326-2639
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005536208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery