Provider Demographics
NPI:1629867395
Name:VILLALOBOS, MICA T (CPT-1)
Entity type:Individual
Prefix:
First Name:MICA
Middle Name:T
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:CPT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 HICKEY BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4371
Mailing Address - Country:US
Mailing Address - Phone:415-318-0314
Mailing Address - Fax:
Practice Address - Street 1:657 HICKEY BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4371
Practice Address - Country:US
Practice Address - Phone:415-318-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-02460261246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy