Provider Demographics
NPI:1427293901
Name:VILLALOBOS, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7323
Mailing Address - Street 2:CARR 146 KM 21.0
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-9716
Mailing Address - Country:US
Mailing Address - Phone:787-871-5783
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 7323
Practice Address - Street 2:CARR 146 KM 21.0
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-9716
Practice Address - Country:US
Practice Address - Phone:787-871-5783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17378208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17378OtherSTATE LICENSE