1124131602 NPI number — DR. HOLANDA DAVILA M.D.

Table of content: DR. HOLANDA DAVILA M.D. (NPI 1124131602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124131602 NPI number — DR. HOLANDA DAVILA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVILA
Provider First Name:
HOLANDA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124131602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 W. LAS COLINAS BLVD
Provider Second Line Business Mailing Address:
SUITE 2000
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-957-3000
Provider Business Mailing Address Fax Number:
972-608-7003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3050 S. 1ST ST.
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-501-0856
Provider Business Practice Location Address Fax Number:
972-608-7003
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L4188 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 116806000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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