Healthcare Provider Details

I. General information

NPI: 1902010531
Provider Name (Legal Business Name): ENRIQUE DAVILA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7431 N UNIVERSITY DR SUITE 110
TAMARAC FL
33321-2956
US

IV. Provider business mailing address

1959 SECOFFEE ST
MIAMI FL
33133-3210
US

V. Phone/Fax

Practice location:
  • Phone: 954-726-0035
  • Fax: 954-726-4774
Mailing address:
  • Phone: 954-726-0035
  • Fax: 954-726-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME31035
License Number StateFL

VIII. Authorized Official

Name: ENRIQUE DAVILA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-726-0035