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General NPI Number Information
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NPI Number | 1336736867
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Entity Type | Individual
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Provider Name | SILVIA MARIA VILLALOBOS SANCHO
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Gender | Female
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 801 S PAULINA ST
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City | CHICAGO
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State | IL
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Zip | 60612-7210
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Country | US
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Telephone | 312-413-4467
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 E 53RD ST UNIT 614
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City | CHICAGO
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State | IL
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Zip | 60615-4380
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Country | US
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Telephone | 608-628-8911
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 019.033152
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12013313A
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License Number State | IN
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