Provider Demographics
NPI:1528676806
Name:VILLALOBOS, YURIDIA
Entity type:Individual
Prefix:MRS
First Name:YURIDIA
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:YURIDIA
Other - Middle Name:
Other - Last Name:IZAZAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:WA
Mailing Address - Zip Code:99323-9700
Mailing Address - Country:US
Mailing Address - Phone:509-314-9170
Mailing Address - Fax:
Practice Address - Street 1:149 2ND AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:WA
Practice Address - Zip Code:99323-9700
Practice Address - Country:US
Practice Address - Phone:509-314-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC18201172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker