David Cevallos MD Inc

Primary specialty

ContractorTaxonomy code 171W00000X

License

B5688077 Issued in CA

Legal business name

DAVID CEVALLOS MD INC

Practice address

616 St Paul Ave
Apt. 417
Los Angeles, CA 90017-2022

Phone

(323) 360-8421

Fax

(626) 380-4743

NPI assigned

Dec 16, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Cevallos, MD

Title

Ceo

Phone

(323) 360-8421

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450224000000",
    "number": "1689039760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 ST PAUL AVE",
            "address_2": "APT. 417",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900172022",
            "telephone_number": "323-360-8421",
            "fax_number": "626-380-4743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 ST PAUL AVE",
            "address_2": "APT. 417",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900172022",
            "telephone_number": "323-360-8421",
            "fax_number": "626-380-4743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID CEVALLOS MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-16",
        "last_updated": "2015-12-16",
        "status": "A",
        "authorized_official_last_name": "CEVALLOS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-360-8421",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Contractor",
            "state": "CA",
            "license": "B5688077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Contractor in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Contractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.