Healthcare Provider Details

I. General information

NPI: 1639148877
Provider Name (Legal Business Name): ELSIE A. DAVILA-TORRES M.D/
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 12/13/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 E BUSCH BLVD
TAMPA FL
33617-5303
US

IV. Provider business mailing address

109 W FORTUNE ST APT 1225
TAMPA FL
33602-3209
US

V. Phone/Fax

Practice location:
  • Phone: 813-984-8846
  • Fax: 813-984-8827
Mailing address:
  • Phone: 786-863-2205
  • Fax: 813-984-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9489
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME57590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: