Provider Demographics
NPI:1124273941
Name:DAVALOS, PHILLIP (RT)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:DAVALOS
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24581 CALLE PERLA
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4358
Mailing Address - Country:US
Mailing Address - Phone:951-834-8470
Mailing Address - Fax:
Practice Address - Street 1:24581 CALLE PERLA
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4358
Practice Address - Country:US
Practice Address - Phone:951-834-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist