Provider Demographics
NPI:1669796355
Name:VILLALOBOS, JAVIER ENRIQUE (OD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:ENRIQUE
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5259 CORTEEN PL
Mailing Address - Street 2:APT 214
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2593
Mailing Address - Country:US
Mailing Address - Phone:559-907-4097
Mailing Address - Fax:
Practice Address - Street 1:14425 CHASE ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3017
Practice Address - Country:US
Practice Address - Phone:818-891-6711
Practice Address - Fax:818-891-5272
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13781 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist