Healthcare Provider Details

I. General information

NPI: 1225037591
Provider Name (Legal Business Name): TIBISAY I VILLALOBOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S CEDAR CREST BLVD SUITE 2400
ALLENTOWN PA
18103-6229
US

IV. Provider business mailing address

1210 S CEDAR CREST BLVD SUITE 2400
ALLENTOWN PA
18103-6229
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-3824
  • Fax: 610-402-3893
Mailing address:
  • Phone: 610-402-3824
  • Fax: 610-402-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD447355
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: