Provider Demographics
NPI:1629715347
Name:VILLALOBOS PALACIOS, MARIA ALEJANDRA (SA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEJANDRA
Last Name:VILLALOBOS PALACIOS
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 NW 107TH AVE UNIT L507
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2898
Mailing Address - Country:US
Mailing Address - Phone:786-856-0723
Mailing Address - Fax:
Practice Address - Street 1:1750 NW 107TH AVE UNIT L507
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2898
Practice Address - Country:US
Practice Address - Phone:786-856-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22-177246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant