MEDICARE: HUMBERTO DAVILA OPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1285765123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUMBERTO DAVILA OPA-C

Provider Business Mailing Address
First Line	:	1525 E WINDMILL LANE
Second Line	:	SUITE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1903
Country	:	US
Telephone Number	:	702-434-6920
Fax Number	:	702-434-1524

Provider Business Practice Location Address
First Line	:	1525 E. WINDMILL LANE
Second Line	:	SUITE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1903
Country	:	US
Telephone Number	:	702-434-6920
Fax Number	:	702-434-1524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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