Provider Demographics
NPI:1619853827
Name:DAVILA PARTIDA, JONATHAN (LMBT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:DAVILA PARTIDA
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 MCKAY DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-8622
Mailing Address - Country:US
Mailing Address - Phone:310-612-5389
Mailing Address - Fax:
Practice Address - Street 1:4140 FERNCREEK DR STE 702
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2569
Practice Address - Country:US
Practice Address - Phone:910-514-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20413225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist