Provider Demographics
NPI:1881812717
Name:VILLALOBOS, MARINA TIJERINA (OD)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:TIJERINA
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 YUCCA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2851
Mailing Address - Country:US
Mailing Address - Phone:956-330-5792
Mailing Address - Fax:
Practice Address - Street 1:701 YUCCA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2851
Practice Address - Country:US
Practice Address - Phone:956-330-5792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06342TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist