Healthcare Provider Details

I. General information

NPI: 1750367835
Provider Name (Legal Business Name): GIANINA ALICIA DAVILA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GIANINA ALICIA DAVILA-ZASLOFF MD

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON STREET
HOLLYWOOD FL
33321
US

IV. Provider business mailing address

1613 N. HARRISON PARKWAY, SUITE 200 MAILSTOP SH-9A
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-5324
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME73695
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME73695
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: