Healthcare Provider Details

I. General information

NPI: 1497743348
Provider Name (Legal Business Name): RAMON A. DAVILA ORTIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CALLE HERNAN ALVAREZ PLAZA METROPOLITANA, SUITE 107
SAN GERMAN PR
00683-4173
US

IV. Provider business mailing address

PO BOX 183
SAN GERMAN PR
00683-0183
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-0399
  • Fax: 787-892-6250
Mailing address:
  • Phone: 787-892-0399
  • Fax: 787-892-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number11066
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: