Healthcare Provider Details

I. General information

NPI: 1376580597
Provider Name (Legal Business Name): RAYMOND M VILLALOBOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAY VILLALOBOS M.D.

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/23/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S COWLEY ST STE 210
SPOKANE WA
99202
US

IV. Provider business mailing address

168 SOUTH ST
SHREWSBURY MA
01545-5402
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-6706
  • Fax: 509-473-6704
Mailing address:
  • Phone: 508-523-4218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number78395
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD17230
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD00030129
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number78914
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: