Healthcare Provider Details

I. General information

NPI: 1073572228
Provider Name (Legal Business Name): MIGUEL A VILLALOBOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 W STATE ROAD 73
SARATOGA SPRINGS UT
84045-2901
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-341-5200
  • Fax:
Mailing address:
  • Phone: 801-357-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG77997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: