Healthcare Provider Details

I. General information

NPI: 1184851370
Provider Name (Legal Business Name): RAFAEL ANGEL DAVILA III ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 BRIDGEWAY BLVD
ORLANDO FL
32828-6178
US

IV. Provider business mailing address

1024 BRIDGEWAY BLVD
ORLANDO FL
32828-6178
US

V. Phone/Fax

Practice location:
  • Phone: 407-282-5521
  • Fax:
Mailing address:
  • Phone: 407-282-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number744979
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number43095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: