Provider Demographics
NPI:1801607197
Name:RODRIGUEZ-DAVILA, GENISIS A
Entity type:Individual
Prefix:
First Name:GENISIS
Middle Name:A
Last Name:RODRIGUEZ-DAVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16991 VIA CORTO E
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-7273
Mailing Address - Country:US
Mailing Address - Phone:442-238-8226
Mailing Address - Fax:
Practice Address - Street 1:16991 VIA CORTO E
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-7273
Practice Address - Country:US
Practice Address - Phone:442-238-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician