Provider Demographics
NPI:1942586425
Name:DAVILA, CARLOS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:DAVILA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1609
Mailing Address - Country:US
Mailing Address - Phone:323-893-0124
Mailing Address - Fax:
Practice Address - Street 1:11907 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3113
Practice Address - Country:US
Practice Address - Phone:626-450-0536
Practice Address - Fax:626-450-0569
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist