Provider Demographics
NPI:1649895947
Name:LABOY DAVILA, JOSE ROBERTO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ROBERTO
Last Name:LABOY 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 1:1420 LOMBARD ST APT 1707
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-8282
Mailing Address - Country:US
Mailing Address - Phone:939-216-5724
Mailing Address - Fax:
Practice Address - Street 1:1901 N RICE AVE # 170180
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7912
Practice Address - Country:US
Practice Address - Phone:805-826-9000
Practice Address - Fax:833-294-4737
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty