Provider Demographics
NPI:1740098425
Name:VILLALOBOS, ADRIAN MANUEL (LMT, BS, MS)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MANUEL
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:LMT, BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5162
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2459
Mailing Address - Country:US
Mailing Address - Phone:282-764-7119
Mailing Address - Fax:
Practice Address - Street 1:1001 W 16TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4547
Practice Address - Country:US
Practice Address - Phone:928-276-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-25594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist