Provider Demographics
NPI:1508823337
Name:DAVALOS, HUGO ADRIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:HUGO
Middle Name:ADRIANO
Last Name:DAVALOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:# 104
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-780-3306
Mailing Address - Fax:703-780-6663
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:#104
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-780-3306
Practice Address - Fax:703-780-6663
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025745174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000L86H76Medicare PIN
VAG00276Medicare UPIN