Healthcare Provider Details

I. General information

NPI: 1619581618
Provider Name (Legal Business Name): EDWIN G DAVILA-TORRES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

IV. Provider business mailing address

16056 HARVEST MOON ST
LA PUENTE CA
91744-1334
US

V. Phone/Fax

Practice location:
  • Phone: 760-837-8131
  • Fax:
Mailing address:
  • Phone: 626-367-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number40356
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95387948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: