Provider Demographics
NPI:1962290502
Name:VILLALOBOS, AMALIA ROSANNA
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:ROSANNA
Last Name:VILLALOBOS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11997 BLUE GRAY TRL
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:WV
Mailing Address - Zip Code:26802-8064
Mailing Address - Country:US
Mailing Address - Phone:304-249-5544
Mailing Address - Fax:
Practice Address - Street 1:11997 BLUE GRAY TRL
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:WV
Practice Address - Zip Code:26802-8064
Practice Address - Country:US
Practice Address - Phone:304-249-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant