MEDICARE: RAFAEL VILLALOBOS MD PA

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	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	K9927	TX

General Provider Information

NPI Number	:	1386731073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAFAEL VILLALOBOS MD PA

Provider Business Mailing Address
First Line	:	PO BOX 5719
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78523-5719
Country	:	US
Telephone Number	:	956-350-0779
Fax Number	:	956-350-3006

Provider Business Practice Location Address
First Line	:	4770 N EXPRESSWAY # 83
Second Line	:	SUITE 102
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-4120
Country	:	US
Telephone Number	:	956-350-0779
Fax Number	:	956-350-3006

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAFAEL VILLALOBOS
Credential	:	MD
Telephone Number	:	956-350-0779

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	03/16/2009

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