Provider Demographics
NPI:1609543669
Name:DAVILA, ALYSSA LOREN
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LOREN
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 1:3500 LEOPARD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78408-3204
Mailing Address - Country:US
Mailing Address - Phone:361-883-7196
Mailing Address - Fax:
Practice Address - Street 1:3500 LEOPARD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78408-3204
Practice Address - Country:US
Practice Address - Phone:361-883-7196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician