Healthcare Provider Details

I. General information

NPI: 1306642665
Provider Name (Legal Business Name): DAYANERA ALONDRA CALVILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 10TH AVE
SIDNEY NE
69162-1609
US

IV. Provider business mailing address

1415 1ST AVE
SCOTTSBLUFF NE
69361-3104
US

V. Phone/Fax

Practice location:
  • Phone: 308-249-0718
  • Fax: 308-249-0718
Mailing address:
  • Phone: 817-550-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: