Provider Demographics
NPI:1336195718
Name:VILLALOBOS, JACKELINNE PILAR (DO)
Entity Type:Individual
Prefix:
First Name:JACKELINNE
Middle Name:PILAR
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11307 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3687
Mailing Address - Country:US
Mailing Address - Phone:713-517-0200
Mailing Address - Fax:713-517-0201
Practice Address - Street 1:11307 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3687
Practice Address - Country:US
Practice Address - Phone:713-517-0200
Practice Address - Fax:713-517-0201
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226308207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H81753Medicare UPIN