Provider Demographics
NPI:1992926661
Name:CEVALLOS, SALVADOR (MD)
Entity type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:
Last Name:CEVALLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 S RIDGEWOOD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2240
Mailing Address - Country:US
Mailing Address - Phone:386-957-3905
Mailing Address - Fax:386-492-1131
Practice Address - Street 1:2089 S RIDGEWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2240
Practice Address - Country:US
Practice Address - Phone:386-957-3905
Practice Address - Fax:386-492-1131
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1016962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry