Provider Demographics
NPI:1689116683
Name:DAVILA, LEONARD
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:DAVILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WILLOW LOOP
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4298
Mailing Address - Country:US
Mailing Address - Phone:210-300-3701
Mailing Address - Fax:877-497-6972
Practice Address - Street 1:317 WILLOW LOOP
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-4298
Practice Address - Country:US
Practice Address - Phone:210-300-3701
Practice Address - Fax:877-497-6972
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist