Provider Demographics
NPI:1598710824
Name:VILLALOBOS, JACQUELINE (ND)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N CAMPO ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3433
Mailing Address - Country:US
Mailing Address - Phone:575-915-5808
Mailing Address - Fax:575-215-5523
Practice Address - Street 1:330 N CAMPO ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3433
Practice Address - Country:US
Practice Address - Phone:575-915-5808
Practice Address - Fax:575-215-5523
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1063175F00000X
NMND-0002175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath