Provider Demographics
NPI:1053644732
Name:DAVALOS, JAZMIN E
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:E
Last Name:DAVALOS
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 1:8700 CLETA ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5203
Mailing Address - Country:US
Mailing Address - Phone:562-862-9766
Mailing Address - Fax:562-862-5137
Practice Address - Street 1:8700 CLETA ST
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5203
Practice Address - Country:US
Practice Address - Phone:562-862-9766
Practice Address - Fax:562-862-5137
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1412281101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)