Healthcare Provider Details

I. General information

NPI: 1184105165
Provider Name (Legal Business Name): LEOMAR DAVILA RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CORPORATE BLVD S
YONKERS NY
10701-6862
US

IV. Provider business mailing address

2016 E COMANCHE AVE
TAMPA FL
33610-8228
US

V. Phone/Fax

Practice location:
  • Phone: 914-294-6300
  • Fax:
Mailing address:
  • Phone: 813-557-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: