MEDICARE: DR. OSCAR DEMETRIO VILLALOBOS NP

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	101YM0800X	Mental Health Counselor	62751	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP133327	TX

General Provider Information

NPI Number	:	1528181492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSCAR DEMETRIO VILLALOBOS NP

Provider Business Mailing Address
First Line	:	201 E MAIN DR STE 600
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79901-1385
Country	:	US
Telephone Number	:	915-887-3410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 MONTANA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-5622
Country	:	US
Telephone Number	:	915-203-8186
Fax Number	:

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

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	04/06/2017

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