Provider Demographics
NPI:1730428814
Name:VILLALOBOS, ASTRID A (SLP)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:A
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 N KROME AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2406
Mailing Address - Country:US
Mailing Address - Phone:305-247-4464
Mailing Address - Fax:305-247-4546
Practice Address - Street 1:1380 N KROME AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-2406
Practice Address - Country:US
Practice Address - Phone:305-247-4464
Practice Address - Fax:305-247-4546
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist