MEDICARE: DR. CARLOS DAVILA PHARMD

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	183500000X	Pharmacist	64776	CA

General Provider Information

NPI Number	:	1942586425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS DAVILA PHARMD

Provider Business Mailing Address
First Line	:	3044 OREGON ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1609
Country	:	US
Telephone Number	:	323-893-0124
Fax Number	:

Provider Business Practice Location Address
First Line	:	11907 VALLEY BLVD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-3113
Country	:	US
Telephone Number	:	626-450-0536
Fax Number	:	626-450-0569

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

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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Directions to “ DR. CARLOS DAVILA PHARMD” Practice Location

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