=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487478020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECA ANGELICA DAVILA MS, RDN, LD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2024
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 N MCCOLL RD STE A
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78501-9365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-600-3475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 421 E THOMAS RD APT 1116
-----------------------------------------------------
City | PHARR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78577-5391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-855-8966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DT90569
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------