Healthcare Provider Details

I. General information

NPI: 1053063511
Provider Name (Legal Business Name): ADRIANA VILLALOBOS MA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3392 TIMBERWOOD CIR OFC
NAPLES FL
34105-5630
US

IV. Provider business mailing address

3392 TIMBERWOOD CIR
NAPLES FL
34105-5630
US

V. Phone/Fax

Practice location:
  • Phone: 239-777-2089
  • Fax:
Mailing address:
  • Phone: 239-777-2089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA VILLALOBOS
Title or Position: OWNER AUDIOLOGIST
Credential: MA
Phone: 239-777-2089