Provider Demographics
NPI:1669042073
Name:DAVILA, YOSIAH (BT)
Entity Type:Individual
Prefix:
First Name:YOSIAH
Middle Name:
Last Name:DAVILA
Suffix:
Gender:M
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 HILLRISE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4759
Mailing Address - Country:US
Mailing Address - Phone:575-522-9500
Mailing Address - Fax:575-523-1108
Practice Address - Street 1:1415 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-2013
Practice Address - Country:US
Practice Address - Phone:575-623-2615
Practice Address - Fax:575-622-6703
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician