Healthcare Provider Details

I. General information

NPI: 1942773825
Provider Name (Legal Business Name): EDILBERTO DAVILA MARIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S 10TH ST
HAINES CITY FL
33844-5304
US

IV. Provider business mailing address

118 S 10TH ST
HAINES CITY FL
33844-5304
US

V. Phone/Fax

Practice location:
  • Phone: 407-460-9909
  • Fax: 407-350-5890
Mailing address:
  • Phone: 863-204-8000
  • Fax: 407-350-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: EDILBERTO DAVILA MARIN
Title or Position: CO-OWNER
Credential:
Phone: 407-460-9909