Provider Demographics
NPI:1316692882
Name:HERNANDEZ DAVILA, RAYMUNDO
Entity type:Individual
Prefix:
First Name:RAYMUNDO
Middle Name:
Last Name:HERNANDEZ DAVILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E 1ST ST APT A
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-2837
Mailing Address - Country:US
Mailing Address - Phone:686-135-6539
Mailing Address - Fax:
Practice Address - Street 1:515 E 1ST ST APT A
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2837
Practice Address - Country:US
Practice Address - Phone:686-135-6539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician