Healthcare Provider Details

I. General information

NPI: 1306825666
Provider Name (Legal Business Name): LALAINE DE LEON VILLAROJO M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 11/13/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11335 SGT SIMS
FT BLISS TX
79918
US

IV. Provider business mailing address

1412 ARROW RIDGE WAY
EL PASO TX
79912-8109
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-1437
  • Fax: 915-742-4933
Mailing address:
  • Phone: 915-873-7129
  • Fax: 915-742-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK6376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: