Provider Demographics
NPI:1114761426
Name:VILLALOBOS, TREVOR (BS CRIMINAL JUSTICE)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:BS CRIMINAL JUSTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S 500 E UNIT 305
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2784
Mailing Address - Country:US
Mailing Address - Phone:801-252-6646
Mailing Address - Fax:
Practice Address - Street 1:13691 S BROWN FARM LN
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7809
Practice Address - Country:US
Practice Address - Phone:801-407-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator