Provider Demographics
NPI:1790129484
Name:DAVALOS, ANNA VLADIMIROVNA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:VLADIMIROVNA
Last Name:DAVALOS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:V
Other - Last Name:GRIGORIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1111 AUSTIN HWY APT 2109
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4842
Mailing Address - Country:US
Mailing Address - Phone:863-255-5550
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX868890367500000X
PARN648343367500000X, 367500000X
TXAP127182367500000X
FLRN9294561367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered