Provider Demographics
NPI:1720568306
Name:DAVILA, ALEIDA MALDONADO
Entity Type:Individual
Prefix:
First Name:ALEIDA
Middle Name:MALDONADO
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:PO BOX 1032
Mailing Address - Street 2:
Mailing Address - City:LA BLANCA
Mailing Address - State:TX
Mailing Address - Zip Code:78558-1032
Mailing Address - Country:US
Mailing Address - Phone:956-513-1377
Mailing Address - Fax:956-513-1387
Practice Address - Street 1:13600 E STATE HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-1644
Practice Address - Country:US
Practice Address - Phone:956-513-1377
Practice Address - Fax:956-513-1387
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care