Provider Demographics
NPI:1932446960
Name:VILLALOBOS, ALEJANDRO T
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:T
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 N 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1222
Mailing Address - Country:US
Mailing Address - Phone:940-224-4004
Mailing Address - Fax:
Practice Address - Street 1:242 N 34TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1222
Practice Address - Country:US
Practice Address - Phone:940-224-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education