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NPI Code Detail

MEDICARE: MR. LUIS EDUARDO DAVILA M.A

MEDICARE: MR. LUIS EDUARDO DAVILA M.A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103TS0200XSchool Psychologist3705PR

General Provider Information

NPI Number : 1881965697
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LUIS EDUARDO DAVILA M.A
Provider Business Mailing Address
First Line : 2950 SAN JUAN CIR APT 322
Second Line :
City : KISSIMMEE
State : FL
Zip : 34746-4898
Country : US
Telephone Number : 407-653-9370
Fax Number :
Provider Business Practice Location Address
First Line : 3831 W VINE ST STE 60
Second Line :
City : KISSIMMEE
State : FL
Zip : 34741-4650
Country : US
Telephone Number : 407-559-4854
Fax Number : 321-332-7799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2012
Last Update Date : 11/18/2020

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