Provider Demographics
NPI:1649887092
Name:JACQUELINE VILLALOBOS ND LLC
Entity type:Organization
Organization Name:JACQUELINE VILLALOBOS ND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:575-915-5808
Mailing Address - Street 1:330 N CAMPO ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3433
Mailing Address - Country:US
Mailing Address - Phone:575-915-5808
Mailing Address - Fax:575-215-5523
Practice Address - Street 1:330 N CAMPO ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3433
Practice Address - Country:US
Practice Address - Phone:575-915-5808
Practice Address - Fax:575-215-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center