Individual
PRISMA DAVALOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
42121 US HWY 70, PORTALES, NM 88130
(575) 356-6652
(575) 359-6827
Mailing address
PO BOX 299, PORTALES, NM 88130-0299
(575) 356-6652
(575) 359-6827
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
08/04/2022
Last updated
12/31/2024
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