MEDICARE: DR. LALAINE DE LEON VILLAROJO M. D.

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
1	208000000X	Pediatrics Physician	K6376	TX

General Provider Information

NPI Number	:	1306825666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LALAINE DE LEON VILLAROJO M. D.

Provider Business Mailing Address
First Line	:	1412 ARROW RIDGE WAY
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-8109
Country	:	US
Telephone Number	:	915-873-7129
Fax Number	:	915-742-4933

Provider Business Practice Location Address
First Line	:	11335 SGT SIMS
Second Line	:
City	:	FT BLISS
State	:	TX
Zip	:	79918
Country	:	US
Telephone Number	:	915-742-1437
Fax Number	:	915-742-4933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	11/13/2023

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