Provider Demographics
NPI:1801991369
Name:VILLALOBOS, MARGIE (RD, LD)
Entity type:Individual
Prefix:MS
First Name:MARGIE
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MS
Other - First Name:MARGIE
Other - Middle Name:
Other - Last Name:VILLALOBOS-LOEZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD
Mailing Address - Street 1:7149 OVAL ROCK DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7679
Mailing Address - Country:US
Mailing Address - Phone:915-276-3107
Mailing Address - Fax:
Practice Address - Street 1:7149 OVAL ROCK DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7679
Practice Address - Country:US
Practice Address - Phone:915-276-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05717133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612167Medicare ID - Type Unspecified