Provider Demographics
NPI:1043961998
Name:DAVALOS-BARRETO, VIANNEY
Entity Type:Individual
Prefix:
First Name:VIANNEY
Middle Name:
Last Name:DAVALOS-BARRETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32395 CLINTON KEITH RD STE B12
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7568
Mailing Address - Country:US
Mailing Address - Phone:951-200-5532
Mailing Address - Fax:
Practice Address - Street 1:32395 CLINTON KEITH RD STE B12
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7568
Practice Address - Country:US
Practice Address - Phone:951-200-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician