Provider Demographics
NPI:1356928790
Name:VILLALOBOS, MARIA I (NP-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:I
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 WELLNESS WAY STE 506
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4145
Mailing Address - Country:US
Mailing Address - Phone:702-823-0004
Mailing Address - Fax:702-786-6650
Practice Address - Street 1:2020 WELLNESS WAY STE 506
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4145
Practice Address - Country:US
Practice Address - Phone:702-823-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV839393207RT0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant HepatologyGroup - Single Specialty