Basic Information
| Provider Information | |||||||||
| NPI: | 1760845713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVILA-LARROCA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11001 EXECUTIVE CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012027395 | ||||||||
| FaxNumber: | 5012027333 | ||||||||
| Practice Location | |||||||||
| Address1: | 9501 BAPTIST HEALTH DR FL 1 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012027395 | ||||||||
| FaxNumber: | 5012027333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2016 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | E-14394 | AR | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.