Provider Demographics
NPI:1982744496
Name:VILLALOBOS, LINDA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5722
Mailing Address - Country:US
Mailing Address - Phone:540-368-9380
Mailing Address - Fax:540-368-9382
Practice Address - Street 1:603 KENMORE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5722
Practice Address - Country:US
Practice Address - Phone:540-368-9380
Practice Address - Fax:540-368-9382
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF21927Medicare UPIN
VA578413Medicare ID - Type Unspecified