Provider Demographics
NPI:1710956339
Name:VILLALOBOS ORTIZ, CYNTHIA E (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:E
Last Name:VILLALOBOS ORTIZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1400
Mailing Address - Country:US
Mailing Address - Phone:787-860-4090
Mailing Address - Fax:787-863-5515
Practice Address - Street 1:#61 AVENIDA GARRIDO MORALES
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-4090
Practice Address - Fax:787-863-5515
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058123Medicare ID - Type Unspecified