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General NPI Number Information
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NPI Number | 1295460194
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Entity Type | Individual
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Provider Name | DAVIS ANDREA FABIOLA GATICA PADILLA
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Gender | Female
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Dates
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Enumeration Date | 07/24/2022
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2945 PETERS CREEK RD NW
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City | ROANOKE
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State | VA
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Zip | 24019-3513
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Country | US
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Telephone | 540-562-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 395 BRITTANY FARMS RD
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City | NEW BRITAIN
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State | CT
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Zip | 06053-1100
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Country | US
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Telephone | 475-312-4269
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 13528
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401419399
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License Number State | VA
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