Healthcare Provider Details

I. General information

NPI: 1811859234
Provider Name (Legal Business Name): MARALLYS ANNETTE DAVILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14824 SAM GARCIA AVE
EL PASO TX
79938-4889
US

IV. Provider business mailing address

14824 SAM GARCIA AVE
EL PASO TX
79938-4889
US

V. Phone/Fax

Practice location:
  • Phone: 915-274-1445
  • Fax:
Mailing address:
  • Phone: 915-274-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number532306
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number532606
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number532306
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number532306
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: