MEDICARE: JASON 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
1	225700000X	Massage Therapist	42634	CA

General Provider Information

NPI Number	:	1316457658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON VILLALOBOS

Provider Business Mailing Address
First Line	:	14159 GILMORE ST APT 5
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-6547
Country	:	US
Telephone Number	:	214-690-7980
Fax Number	:

Provider Business Practice Location Address
First Line	:	5444 YOLANDA AVE STE 210
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-6305
Country	:	US
Telephone Number	:	310-598-1533
Fax Number	:

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

Provider Enumeration Date	:	09/30/2017
Last Update Date	:	09/30/2017

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Directions to “ JASON VILLALOBOS ” Practice Location

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