Provider Demographics
NPI:1184377301
Name:DAVALOS, ALESSANDRA DAISY
Entity type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:DAISY
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 1:2900 GLADES CIR STE 275
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2268
Mailing Address - Country:US
Mailing Address - Phone:954-478-3353
Mailing Address - Fax:
Practice Address - Street 1:2900 GLADES CIR STE 275
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-2268
Practice Address - Country:US
Practice Address - Phone:954-478-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000979200Medicaid