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General NPI Number Information
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NPI Number | 1871220327
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Entity Type | Individual
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Provider Name | PRISMA DAVALOS PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 42121 US HWY 70
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City | PORTALES
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State | NM
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Zip | 88130
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Country | US
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Telephone | 575-356-6652
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Fax | 575-359-6827
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Provider Business Mailing Address
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Address Line | PO BOX 299
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City | PORTALES
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State | NM
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Zip | 88130-0299
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Country | US
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Telephone | 575-356-6652
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Fax | 575-359-6827
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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