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General NPI Number Information
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NPI Number | 1669796355
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Entity Type | Individual
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Provider Name | JAVIER ENRIQUE VILLALOBOS O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 14425 CHASE ST
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City | PANORAMA CITY
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State | CA
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Zip | 91402-3017
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Country | US
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Telephone | 818-891-6711
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Fax | 818-891-5272
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Provider Business Mailing Address
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Address Line | 5259 CORTEEN PL APT 214
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-2593
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Country | US
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Telephone | 559-907-4097
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13781 TLG
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License Number State | CA
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