Provider Demographics
NPI:1184371973
Name:VILLALOBOS TEJADA, JAIRO OSMIN
Entity type:Individual
Prefix:
First Name:JAIRO
Middle Name:OSMIN
Last Name:VILLALOBOS TEJADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CHILDRENS CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-6558
Mailing Address - Country:US
Mailing Address - Phone:707-565-6350
Mailing Address - Fax:
Practice Address - Street 1:112 CHILDRENS CIR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-6558
Practice Address - Country:US
Practice Address - Phone:707-565-6350
Practice Address - Fax:707-565-6350
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker