Provider Demographics
NPI:1922638766
Name:DAVILA, RODNEY
Entity Type:Individual
Prefix:
First Name:RODNEY
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 1:13891 TUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1926
Mailing Address - Country:US
Mailing Address - Phone:213-703-1576
Mailing Address - Fax:
Practice Address - Street 1:16130 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-3907
Practice Address - Country:US
Practice Address - Phone:818-285-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty