Provider Demographics
NPI:1528181492
Name:VILLALOBOS, OSCAR DEMETRIO (NP)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:DEMETRIO
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E MAIN DR STE 600
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1385
Mailing Address - Country:US
Mailing Address - Phone:915-887-3410
Mailing Address - Fax:
Practice Address - Street 1:1600 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5622
Practice Address - Country:US
Practice Address - Phone:915-203-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62751101YM0800X
TXAP133327363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health