Healthcare Provider Details

I. General information

NPI: 1023214384
Provider Name (Legal Business Name): HECTOR VILLALOBOS LPC, CAC III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S. WADSWORTH BLVD. #106
LAKEWOOD CO
80232
US

IV. Provider business mailing address

P.O. BOX 36121
DENVER CO
80236
US

V. Phone/Fax

Practice location:
  • Phone: 303-949-8616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number4677
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: