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General NPI Number Information
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NPI Number | 1205079514
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Entity Type | Individual
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Provider Name | ANNA DAVILA PA
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Gender | Female
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Dates
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Enumeration Date | 04/16/2009
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 1001 SYLVAN AVE STE A
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City | MODESTO
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State | CA
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Zip | 95350-1699
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Country | US
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Telephone | 209-422-6120
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 SYLVAN AVE STE A
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City | MODESTO
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State | CA
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Zip | 95350-1699
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Country | US
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Telephone | 94-226-1202
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 013253
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License Number State | NY
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