Healthcare Provider Details

I. General information

NPI: 1659299782
Provider Name (Legal Business Name): ROSALBA VILLALOBOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3698 ROAD F NE
MOSES LAKE WA
98837-9620
US

IV. Provider business mailing address

3698 ROAD F NE
MOSES LAKE WA
98837-9620
US

V. Phone/Fax

Practice location:
  • Phone: 509-771-3097
  • Fax:
Mailing address:
  • Phone: 509-771-3097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number605120899
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: