Healthcare Provider Details

I. General information

NPI: 1346294428
Provider Name (Legal Business Name): MR. XAVIER VILLALOBOS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C1 CALLE 2 URB. VILLA REAL
VEGA BAJA PR
00693-3804
US

IV. Provider business mailing address

PO BOX 3307
MANATI PR
00674-3307
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-1735
  • Fax: 787-855-1735
Mailing address:
  • Phone: 787-855-1735
  • Fax: 787-855-1735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number1315
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: