Healthcare Provider Details

I. General information

NPI: 1407976038
Provider Name (Legal Business Name): KATHERINE DAVILA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 CALLE JOSE I QUINTON
COAMO PR
00769-3049
US

IV. Provider business mailing address

PO BOX 2188
COAMO PR
00769-4188
US

V. Phone/Fax

Practice location:
  • Phone: 787-803-0343
  • Fax: 787-803-0343
Mailing address:
  • Phone: 787-803-0343
  • Fax: 787-803-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number11120
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: