Provider Demographics
NPI:1255861894
Name:DAVILA, VICTORIA (NCMA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:NCMA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 S 200 E
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-1645
Mailing Address - Country:US
Mailing Address - Phone:310-529-9043
Mailing Address - Fax:
Practice Address - Street 1:190 S HIGHWAY 165
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9512
Practice Address - Country:US
Practice Address - Phone:435-755-3300
Practice Address - Fax:435-755-3332
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171R00000XOther Service ProvidersInterpreter
No174H00000XOther Service ProvidersHealth Educator