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General NPI Number Information
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NPI Number | 1801616560
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Entity Type | Individual
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Provider Name | TRISTAN DIEGO VILLALOBOS PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1342 PAPERMILL POINTE WAY # K
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City | KNOXVILLE
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State | TN
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Zip | 37909-1903
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Country | US
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Telephone | 865-219-3506
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Fax | 865-588-5711
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Provider Business Mailing Address
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Address Line | 1326 PAPERMILL POINTE WAY # K
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City | KNOXVILLE
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State | TN
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Zip | 37909-1903
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Country | US
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Telephone | 865-219-3506
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Fax | 865-588-5711
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA6226
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License Number State | TN
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