Provider Demographics
NPI:1700331113
Name:DAVILA, JULIA ELENA (MA, MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ELENA
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MA, MS, BCBA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ELENA
Other - Last Name:VALLEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4324
Mailing Address - Country:US
Mailing Address - Phone:310-719-3908
Mailing Address - Fax:
Practice Address - Street 1:1411 W 190TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4324
Practice Address - Country:US
Practice Address - Phone:310-719-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA1-23-67265103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator