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General NPI Number Information
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NPI Number | 1134590680
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Entity Type | Individual
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Provider Name | ANDREW DAVID DAVILA CRAWFORD CATC-III
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Gender | Male
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 14742 NEWPORT AVE
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City | TUSTIN
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State | CA
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Zip | 92780-6177
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Country | US
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Telephone | 949-829-7130
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Fax |
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Provider Business Mailing Address
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Address Line | 21 VIA HONRADO
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-1955
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Country | US
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Telephone | 949-829-7130
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 196897-II
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License Number State | CA
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