Provider Demographics
NPI:1598167918
Name:DAVILA, KENIA I
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:I
Last Name:DAVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12723 ARLINGTON MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-4049
Mailing Address - Country:US
Mailing Address - Phone:787-466-7678
Mailing Address - Fax:
Practice Address - Street 1:4100 N SAM HOUSTON PKWY W STE 240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-1466
Practice Address - Country:US
Practice Address - Phone:787-466-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist