Provider Demographics
NPI:1154715365
Name:AVILA, DANIELLE DEMONTIGNY (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DEMONTIGNY
Last Name:AVILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:DEMONTIGNY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:625 19TH ST. SOUTH
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249
Mailing Address - Country:US
Mailing Address - Phone:970-213-2761
Mailing Address - Fax:
Practice Address - Street 1:3838 N. CAMPBELL AVE
Practice Address - Street 2:BUILDING 2
Practice Address - City:TUSCON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-694-4000
Practice Address - Fax:520-874-7042
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-RES-LIC-42281207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine