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General NPI Number Information
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NPI Number | 1174904833
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Entity Type | Individual
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Provider Name | ANGELICA DAVILA
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Gender | Female
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 2208 CAMINO RAMON
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City | SAN RAMON
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State | CA
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Zip | 94583-1328
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Country | US
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Telephone | 925-830-5133
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Fax | 925-830-5135
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Provider Business Mailing Address
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Address Line | 16180 SILVERLEAF DR
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City | SAN LORENZO
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State | CA
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Zip | 94580-1193
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Country | US
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Telephone | 510-209-3542
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 697
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License Number State | CA
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