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General NPI Number Information
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NPI Number | 1265143341
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Entity Type | Individual
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Provider Name | KIMBERLY ALEXANDRA VILLALOBOS
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Gender | Female
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 5870 EL CAMINO REAL STE 101
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City | CARLSBAD
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State | CA
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Zip | 92008-8816
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Country | US
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Telephone | 858-304-6440
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Fax |
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Provider Business Mailing Address
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Address Line | 402 E 8TH AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-5119
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Country | US
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Telephone | 760-504-4110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 00017755
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License Number State | CA
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