Healthcare Provider Details

I. General information

NPI: 1558658443
Provider Name (Legal Business Name): MS. MARIE DAVALOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DREENA MARIE DAVALOS

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 RICHMOND PKWY STE 201
RICHMOND CA
94806-5878
US

IV. Provider business mailing address

3095 RICHMOND PKWY STE 201
RICHMOND CA
94806-5878
US

V. Phone/Fax

Practice location:
  • Phone: 510-974-6555
  • Fax:
Mailing address:
  • Phone: 510-974-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: