Healthcare Provider Details

I. General information

NPI: 1831274786
Provider Name (Legal Business Name): LOURDES VILLALOBOS ANDAYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST SUITE 819
DETROIT MI
48201-2020
US

IV. Provider business mailing address

4160 JOHN R ST SUITE 819
DETROIT MI
48201-2020
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-2880
  • Fax: 313-832-7845
Mailing address:
  • Phone: 313-832-2880
  • Fax: 313-832-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number32565
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: