Healthcare Provider Details

I. General information

NPI: 1932446960
Provider Name (Legal Business Name): ALEJANDRO T VILLALOBOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 N 34TH ST
SAN JOSE CA
95116-1222
US

IV. Provider business mailing address

242 N 34TH ST
SAN JOSE CA
95116-1222
US

V. Phone/Fax

Practice location:
  • Phone: 940-224-4004
  • Fax:
Mailing address:
  • Phone: 940-224-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: