Basic Information
| Provider Information | |||||||||
| NPI: | 1558858555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLALOBOS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 PERKINS DR STE B | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880053248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755266682 | ||||||||
| FaxNumber: | 5756473777 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 WYATT DR | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880052925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755266682 | ||||||||
| FaxNumber: | 5756473777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2018 | ||||||||
| LastUpdateDate: | 04/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.