Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 263577 | MA |
N | 208000000X | Pediatrician | 263577 | MA |
NPI | 1407101009 |
---|---|
Provider Name | Ricardo F. Villalba Lopez |
First Address | Springfield, MA 01199-1001 |
Second Address | Springfield, MA 01107-1274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 08/12/2017 |