Healthcare Provider Details

I. General information

NPI: 1285682674
Provider Name (Legal Business Name): ROBERT L VILLALOBOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 S SOLANO DR
LAS CRUCES NM
88001-5402
US

IV. Provider business mailing address

2030 S SOLANO DR
LAS CRUCES NM
88001-5402
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-1158
  • Fax: 505-521-1007
Mailing address:
  • Phone: 505-521-1158
  • Fax: 505-521-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberNM83137
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: