Provider Demographics
NPI:1811480528
Name:VILLALOBO, YILAIDIS
Entity type:Individual
Prefix:
First Name:YILAIDIS
Middle Name:
Last Name:VILLALOBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 SW 152ND AVE APT B-102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-4015
Mailing Address - Country:US
Mailing Address - Phone:305-219-6003
Mailing Address - Fax:
Practice Address - Street 1:8555 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:EL PORTAL
Practice Address - State:FL
Practice Address - Zip Code:33138-3001
Practice Address - Country:US
Practice Address - Phone:305-758-5878
Practice Address - Fax:786-991-9371
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN253361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice