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NPI Code Detail

MEDICARE: DR. JUAN FELIPE DAZA OVALLE MD

MEDICARE: DR. JUAN FELIPE DAZA OVALLE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramMT236344PA

General Provider Information

NPI Number : 1427988930
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUAN FELIPE DAZA OVALLE MD
Provider Business Mailing Address
First Line : 5501 OLD YORK RD STE 1
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19141-3098
Country : US
Telephone Number : 484-622-7510
Fax Number :
Provider Business Practice Location Address
First Line : 1330 POWELL ST STE 409
Second Line :
City : NORRISTOWN
State : PA
Zip : 19401-3351
Country : US
Telephone Number : 484-622-7510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2026
Last Update Date : 05/19/2026

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