Provider Demographics
NPI:1912216755
Name:VILLALOBOS, SOPHIA ANN (APN)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ANN
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:APN
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2402 W PIERCE ST
Mailing Address - Street 2:SUITE 6F
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3537
Mailing Address - Country:US
Mailing Address - Phone:575-941-2500
Mailing Address - Fax:575-941-2503
Practice Address - Street 1:2402 W PIERCE ST
Practice Address - Street 2:SUITE 6F
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3537
Practice Address - Country:US
Practice Address - Phone:575-941-2500
Practice Address - Fax:575-941-2503
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX722203363LF0000X
NMCNP02395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX722203OtherLICENSE NUMBER
NMCNP02395OtherLICENSE