Provider Demographics
NPI:1043845704
Name:DAVILA, REBECA ELIZABETH (MS)
Entity type:Individual
Prefix:
First Name:REBECA
Middle Name:ELIZABETH
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:822 CASS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-1116
Mailing Address - Country:US
Mailing Address - Phone:773-987-1357
Mailing Address - Fax:616-414-8530
Practice Address - Street 1:3167 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-1475
Practice Address - Country:US
Practice Address - Phone:773-987-1357
Practice Address - Fax:616-414-8530
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171100000X
IL198000987171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist