Provider Demographics
NPI:1710471321
Name:VILLALOBOS, JESSICA RUBY (LVN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RUBY
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4335
Mailing Address - Country:US
Mailing Address - Phone:951-391-1470
Mailing Address - Fax:
Practice Address - Street 1:601 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4335
Practice Address - Country:US
Practice Address - Phone:951-391-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690702164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse