Healthcare Provider Details

I. General information

NPI: 1699177014
Provider Name (Legal Business Name): DR. KEYLA DAVILA MARCANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 07/14/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE HERNANDEZ CARRION MANATI PROFESSIONAL PLAZA SUITE OFFICE 304
MANATI PR
00674
US

IV. Provider business mailing address

956 CALLE YABOA REAL
SAN JUAN PR
00924-3354
US

V. Phone/Fax

Practice location:
  • Phone: 787-967-9581
  • Fax:
Mailing address:
  • Phone: 787-967-9581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number31266
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10062689
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number21558
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierBP10062689
Identifier TypeOTHER
Identifier StateTX
Identifier IssuerPHYSICIAN INTRAING PERMIT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: