Provider Demographics
NPI:1093495301
Name:CANAVERAL, DAVIDSON CIELO (ATC)
Entity Type:Individual
Prefix:
First Name:DAVIDSON
Middle Name:CIELO
Last Name:CANAVERAL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 BOULDER FALLS ST APT 2181
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4971
Mailing Address - Country:US
Mailing Address - Phone:808-687-0196
Mailing Address - Fax:
Practice Address - Street 1:5880 BOULDER FALLS ST APT 2181
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4971
Practice Address - Country:US
Practice Address - Phone:808-687-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer