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NPI Code Detail

MEDICARE: GLORIA L VILLALOBOS

MEDICARE:   GLORIA L VILLALOBOS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1235456286
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLORIA L VILLALOBOS
Provider Business Mailing Address
First Line : 1100 W STATE ROAD 84
Second Line : SECOND FLOOR
City : FORT LAUDERDALE
State : FL
Zip : 33315-2436
Country : US
Telephone Number : 954-765-0550
Fax Number : 954-765-0587
Provider Business Practice Location Address
First Line : 1100 W STATE ROAD 84
Second Line : SECOND FLOOR
City : FORT LAUDERDALE
State : FL
Zip : 33315-2436
Country : US
Telephone Number : 954-765-0550
Fax Number : 954-765-0587
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2010
Last Update Date : 04/30/2010

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Directions to “ GLORIA L VILLALOBOS ” Practice Location

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