Provider Demographics
NPI:1558658443
Name:DAVALOS, MARIE
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:DAVALOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DREENA
Other - Middle Name:MARIE
Other - Last Name:DAVALOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39420 LIBERTY ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2200
Mailing Address - Country:US
Mailing Address - Phone:510-745-9151
Mailing Address - Fax:
Practice Address - Street 1:39420 LIBERTY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2200
Practice Address - Country:US
Practice Address - Phone:510-745-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator