Provider Demographics
NPI:1962746941
Name:DAVILA-LOSADA, BRIAN ANTHONY
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ANTHONY
Last Name:DAVILA-LOSADA
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 1:4596 FLAMING RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7928
Mailing Address - Country:US
Mailing Address - Phone:702-286-0590
Mailing Address - Fax:
Practice Address - Street 1:5175 CAMINO AL NORTE STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2408
Practice Address - Country:US
Practice Address - Phone:702-648-3913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner