Healthcare Provider Details

I. General information

NPI: 1952251811
Provider Name (Legal Business Name): SEAN DAVILA PHD, CNS (NM)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 WHISPERING MEADOWS DR NE
RIO RANCHO NM
87144-4116
US

IV. Provider business mailing address

504 WHISPERING MEADOWS DR NE
RIO RANCHO NM
87144-4116
US

V. Phone/Fax

Practice location:
  • Phone: 505-252-9080
  • Fax:
Mailing address:
  • Phone: 505-252-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberNDP-2026-0029
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: