Provider Demographics
NPI:1043500077
Name:DAVALOS, MARIA C
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:C
Last Name:DAVALOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:JAVIER
Other - Middle Name:
Other - Last Name:LOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5720 JOE HERRERA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-7409
Mailing Address - Country:US
Mailing Address - Phone:915-346-6514
Mailing Address - Fax:
Practice Address - Street 1:5720 JOE HERRERA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-7409
Practice Address - Country:US
Practice Address - Phone:915-346-6514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator