Healthcare Provider Details

I. General information

NPI: 1447798954
Provider Name (Legal Business Name): HUNALDO J. VILLALOBOS, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W OAK ST SUITE 111
KISSIMMEE FL
34741-4989
US

IV. Provider business mailing address

801 N ORANGE AVE SUITE 720
ORLANDO FL
32801-1026
US

V. Phone/Fax

Practice location:
  • Phone: 407-288-8638
  • Fax: 407-288-8639
Mailing address:
  • Phone: 407-288-8638
  • Fax: 407-288-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME94953
License Number StateFL

VIII. Authorized Official

Name: HUNALDO J VILLALOBOS
Title or Position: OWNER
Credential: M.D.
Phone: 407-288-8638