MEDICARE: DR RICARDO VILLALOBOS GONZALEZ PSC

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	2084N0400X	Neurology Physician	16476	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	337402	OTHER	PR	CERTIFICADO DE REGISTRO DEPARTAMENTO DE ESTADO PUERTO RICO

General Provider Information

NPI Number	:	1861804197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR RICARDO VILLALOBOS GONZALEZ PSC

Provider Business Mailing Address
First Line	:	909 AVE TITO CASTRO STE 804
Second Line	:	TORREMEDICA SAN LUCAS
City	:	PONCE
State	:	PR
Zip	:	00716-4725
Country	:	US
Telephone Number	:	787-648-8115
Fax Number	:	787-651-1498

Provider Business Practice Location Address
First Line	:	909 AVE TITO CASTRO STE 804
Second Line	:	TORREMEDICA SAN LUCAS
City	:	PONCE
State	:	PR
Zip	:	00716-4725
Country	:	US
Telephone Number	:	787-648-8115
Fax Number	:	787-651-1498

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICARDO VILLALOBOS
Credential	:	MD
Telephone Number	:	787-648-8115

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	05/21/2014

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Directions to “DR RICARDO VILLALOBOS GONZALEZ PSC ” Practice Location

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