Provider Demographics
NPI:1790511277
Name:DAVILA, HARRY (EMT)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:DAVILA
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 N EASTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-5117
Mailing Address - Country:US
Mailing Address - Phone:267-456-2709
Mailing Address - Fax:
Practice Address - Street 1:380 RED LION RD STE 235
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6451
Practice Address - Country:US
Practice Address - Phone:833-745-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA193286146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic