Provider Demographics
NPI:1295319853
Name:DAVILA, KANNITHA MAKAYLA-LEE (BA, BS)
Entity type:Individual
Prefix:MISS
First Name:KANNITHA
Middle Name:MAKAYLA-LEE
Last Name:DAVILA
Suffix:
Gender:F
Credentials:BA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 BAGLEY AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-4905
Mailing Address - Country:US
Mailing Address - Phone:361-228-5848
Mailing Address - Fax:
Practice Address - Street 1:6061 BAGLEY AVE APT 18
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-4905
Practice Address - Country:US
Practice Address - Phone:361-228-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst