Active NPI
Mary Loretta Davila, R.D. IBCLC
- Registered Dietitian
- Redwood City, CA
National Provider Identifier
1417309170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 853097
- Practice address
- 2710 Middlefield Rd
Redwood City, CA 94063-3404 - Phone
- (650) 578-7141
- Fax
- (650) 298-6881
- NPI assigned
- Jul 6, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 853097 | CA | Primary |
| Lactation Consultant (Non-RN) | 174N00000X | L-19656 |
Addresses
Primary practice location
2710 Middlefield Rd
Redwood City, CA 94063-3404
Mailing address
2710 Middlefield Rd
Redwood City, CA 94063-3404
Phone (650) 578-7141
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 853097 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467763200000",
"number": "1417309170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2710 MIDDLEFIELD RD",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940633404",
"telephone_number": "650-578-7141",
"fax_number": "650-298-6881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2710 MIDDLEFIELD RD",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940633404",
"telephone_number": "650-578-7141",
"fax_number": "650-298-6881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVILA",
"first_name": "MARY LORETTA",
"credential": "R.D. IBCLC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-06",
"last_updated": "2016-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "853097",
"primary": true
},
{
"code": "174N00000X",
"taxonomy_group": "",
"desc": "Lactation Consultant, Non-RN",
"state": null,
"license": "L-19656",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redwood City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.