Basic Information
| Provider Information | |||||||||
| NPI: | 1184730376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVILA | ||||||||
| FirstName: | ANGEL | ||||||||
| MiddleName: | MANUEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | W5-18 CALLE CERVANTES | ||||||||
| Address2: | HUCARES | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009266804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872832118 | ||||||||
| FaxNumber: | 7872832118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1462 CALLE PROF AUGUSTO RODRIGUE | ||||||||
| Address2: | PAVIA HOSPITAL | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009092145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877270101 | ||||||||
| FaxNumber: | 7877282641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 10304 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.