Individual
LOUIE CHELLE BACALTOS VILLAMOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2165 WHITE BEAR AVE N, MAPLEWOOD, MN 55109-2707
(651) 523-9800
(651) 523-9801
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14164
MN
Other
Enumeration date
03/11/2021
Last updated
09/12/2022
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