Provider Demographics
NPI:1639889835
Name:VILLALOBOS, AIMARA CORINA
Entity Type:Individual
Prefix:
First Name:AIMARA
Middle Name:CORINA
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 NW NORTH RIVER DR STE 345
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2894
Mailing Address - Country:US
Mailing Address - Phone:786-353-9887
Mailing Address - Fax:786-320-6281
Practice Address - Street 1:1440 NW NORTH RIVER DR STE 345
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2894
Practice Address - Country:US
Practice Address - Phone:786-353-9887
Practice Address - Fax:786-320-6281
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDR138181126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant