Basic Information
| Provider Information | |||||||||
| NPI: | 1285605790 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVILA CARMONA | ||||||||
| FirstName: | DALYA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 800 | ||||||||
| Address2: | |||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009860800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877763840 | ||||||||
| FaxNumber: | 7877610613 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR 857 KM 0.4 BARRIO CANOVANILLAS | ||||||||
| Address2: | POLICLINICA DR. SALVADOR RIBOT RUIZ INC., | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009860800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877763840 | ||||||||
| FaxNumber: | 7877610613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 02/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 15973 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 15973 | 01 | LICENCIA | OTHER |