Healthcare Provider Details

I. General information

NPI: 1508808544
Provider Name (Legal Business Name): A ALEX DAVILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36485 INLAND VALLEY DR
WILDOMAR CA
92595-9681
US

IV. Provider business mailing address

41690 IVY ST STE B
MURRIETA CA
92562-9437
US

V. Phone/Fax

Practice location:
  • Phone: 951-677-9773
  • Fax:
Mailing address:
  • Phone: 951-200-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA87117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: