Healthcare Provider Details

I. General information

NPI: 1104201128
Provider Name (Legal Business Name): DAVID ALEXANDER CEVALLOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID ALEXANDER CEVALLOS TOALA M.D.

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE FL 33136
MIAMI FL
33136
US

IV. Provider business mailing address

20801 NW 2ND AVE
MIAMI FL
33169-2103
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-3388
  • Fax:
Mailing address:
  • Phone: 305-653-1770
  • Fax: 305-650-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13820-I
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME140399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: