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NPI Code Detail

MEDICARE: EILEEN DESERI VILLALOBOS

MEDICARE: EILEEN DESERI VILLALOBOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1053245746
Entity Type Code : Individual
Provider Name (Legal Business Name) : EILEEN DESERI VILLALOBOS
Provider Business Mailing Address
First Line : 13128 CORAK ST
Second Line :
City : BALDWIN PARK
State : CA
Zip : 91706-3816
Country : US
Telephone Number : 323-717-5925
Fax Number :
Provider Business Practice Location Address
First Line : 840 N AVENUE 66
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1508
Country : US
Telephone Number : 323-717-5925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2026
Last Update Date : 06/09/2026

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Directions to “ EILEEN DESERI VILLALOBOS ” Practice Location

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