Provider Demographics
NPI:1154723385
Name:VILLALOBOS, CLARA
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:VILLALOBOS
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 1:21353 NE 8TH CT
Mailing Address - Street 2:HOUSE #2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1148
Mailing Address - Country:US
Mailing Address - Phone:305-282-9949
Mailing Address - Fax:
Practice Address - Street 1:21353 NE 8TH CT
Practice Address - Street 2:HOUSE #2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-1148
Practice Address - Country:US
Practice Address - Phone:305-282-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities