Provider Demographics
NPI:1902994551
Name:VILLALVAZO, HUMBERTO JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:JESUS
Last Name:VILLALVAZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HUMBERTO
Other - Middle Name:JESUS
Other - Last Name:VILLALVAZO-CAMACHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-0450
Mailing Address - Country:US
Mailing Address - Phone:559-898-0935
Mailing Address - Fax:559-898-0939
Practice Address - Street 1:1237 ROSE AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3227
Practice Address - Country:US
Practice Address - Phone:559-898-0935
Practice Address - Fax:559-898-0939
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABV9097519OtherDEA
CABV9097519OtherDEA