Provider Demographics
NPI:1215532254
Name:VILLALOBOS, JESSICA ALEXANDRA (RN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ALEXANDRA
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 VILLA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3006
Mailing Address - Country:US
Mailing Address - Phone:915-219-0248
Mailing Address - Fax:
Practice Address - Street 1:444 EXECUTIVE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1058
Practice Address - Country:US
Practice Address - Phone:915-213-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1013262163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse