MEDICARE: DR. MIGUEL A VILLALOBOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G77997	CA

General Provider Information

NPI Number	:	1073572228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL A VILLALOBOS MD

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-357-1770
Fax Number	:

Provider Business Practice Location Address
First Line	:	354 W STATE ROAD 73
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-2901
Country	:	US
Telephone Number	:	801-341-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	01/16/2014

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