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General NPI Number Information
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NPI Number | 1689039760
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Entity Type | Organization
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Legal Business Name | DAVID CEVALLOS MD INC
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 616 ST PAUL AVE APT. 417
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City | LOS ANGELES
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State | CA
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Zip | 90017-2022
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Country | US
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Telephone | 323-360-8421
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Fax | 626-380-4743
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Provider Business Mailing Address
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Address Line | 616 ST PAUL AVE APT. 417
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City | LOS ANGELES
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State | CA
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Zip | 90017-2022
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Country | US
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Telephone | 323-360-8421
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Fax | 626-380-4743
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Authorized Official
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Title or Position | CEO
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Name | DAVID CEVALLOS
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Credential | MD
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Telephone | 323-360-8421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | B5688077
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License Number State | CA
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