Provider Demographics
NPI:1912157694
Name:DAVILA, JEFFREY (MA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:DAVILA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18290 HWY 128
Mailing Address - Street 2:
Mailing Address - City:CALISTOGA
Mailing Address - State:CA
Mailing Address - Zip Code:94515-9532
Mailing Address - Country:US
Mailing Address - Phone:707-484-6986
Mailing Address - Fax:
Practice Address - Street 1:1500 CEDAR ST
Practice Address - Street 2:
Practice Address - City:CALISTOGA
Practice Address - State:CA
Practice Address - Zip Code:94515-1612
Practice Address - Country:US
Practice Address - Phone:707-484-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 27116106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist