Healthcare Provider Details

I. General information

NPI: 1467545400
Provider Name (Legal Business Name): RICARDO RAUL DAVILA II BCHIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 50TH STREET
LUBBOCK TX
79414-5823
US

IV. Provider business mailing address

5303 50TH STREET
LUBBOCK TX
79414-5823
US

V. Phone/Fax

Practice location:
  • Phone: 806-799-8950
  • Fax: 806-792-9404
Mailing address:
  • Phone: 806-799-8950
  • Fax: 806-792-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0621
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number50044
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: