Provider Demographics
NPI:1104201128
Name:CEVALLOS, DAVID ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:CEVALLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:ALEXANDER
Other - Last Name:CEVALLOS TOALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:20801 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2103
Mailing Address - Country:US
Mailing Address - Phone:305-653-1770
Mailing Address - Fax:305-650-0673
Practice Address - Street 1:1611 NW 12TH AVE FL 33136
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-575-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X, 390200000X
PR13820-I390200000X, 390200000X
FLME140399207Q00000X
FLTRN28653390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine