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NPI Code Detail

MEDICARE: THERESA A DAVILA PA-C

MEDICARE: THERESA A DAVILA PA-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
1363A00000XPhysician AssistantPA9110282FL
2363A00000XPhysician Assistant1544NH
3363A00000XPhysician Assistant4837SC
4363AS0400XSurgical Physician Assistant1761TN
5363A00000XPhysician Assistant085011269IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720211451
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA A DAVILA PA-C
Provider Business Mailing Address
First Line : 12251 S 80TH AVE STE 1520
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-1290
Country : US
Telephone Number : 708-923-4200
Fax Number : 708-923-4201
Provider Business Practice Location Address
First Line : 1506 SPRING ST
Second Line :
City : GREENWOOD
State : SC
Zip : 29646-4071
Country : US
Telephone Number : 864-725-7900
Fax Number : 864-725-7910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2009
Last Update Date : 06/24/2025

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Directions to “ THERESA A DAVILA PA-C” Practice Location

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