Provider Demographics
NPI:1831950690
Name:VILLALOBOS, CARLOS
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11981 SW 144TH CT STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8653
Mailing Address - Country:US
Mailing Address - Phone:786-640-0609
Mailing Address - Fax:786-640-0615
Practice Address - Street 1:11981 SW 144TH CT STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8653
Practice Address - Country:US
Practice Address - Phone:786-640-0609
Practice Address - Fax:786-640-0615
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily