Provider Demographics
NPI:1285625533
Name:DAVILLA, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:DAVILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15466 LOS GATOS BLVD
Mailing Address - Street 2:STE 109 PMB 057
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2542
Mailing Address - Country:US
Mailing Address - Phone:408-358-1811
Mailing Address - Fax:408-358-7961
Practice Address - Street 1:14981 NATIONAL AVE
Practice Address - Street 2:STE 6
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2600
Practice Address - Country:US
Practice Address - Phone:408-358-1811
Practice Address - Fax:408-358-7961
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44737174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49733Medicare UPIN
CA00G447370Medicare PIN