MEDICARE: SEAN DAVILA PHD, CNS (NM)

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	133V00000X	Registered Dietitian	NDP-2026-0029	NM

General Provider Information

NPI Number	:	1952251811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN DAVILA PHD, CNS (NM)

Provider Business Mailing Address
First Line	:	504 WHISPERING MEADOWS DR NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-4116
Country	:	US
Telephone Number	:	505-252-9080
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 WHISPERING MEADOWS DR NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-4116
Country	:	US
Telephone Number	:	505-252-9080
Fax Number	:

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

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	04/20/2026

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