MEDICARE: MR. JUAN JAVIER DAVILA-VELAZQUEZ MD

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
1	207L00000X	Anesthesiology Physician	259823	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952600736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUAN JAVIER DAVILA-VELAZQUEZ MD

Provider Business Mailing Address
First Line	:	3450 WAYNE AVE
Second Line	:	APT 3B
City	:	BRONX
State	:	NY
Zip	:	10467-2510
Country	:	US
Telephone Number	:	917-664-3932
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 WAYNE AVE
Second Line	:	APT 3B
City	:	BRONX
State	:	NY
Zip	:	10467-2510
Country	:	US
Telephone Number	:	917-664-3932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2011
Last Update Date	:	03/20/2011

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