Healthcare Provider Details

I. General information

NPI: 1356455224
Provider Name (Legal Business Name): DR. ROBERTO ANTONIO DE FELIX - DAVILA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 CALLE DE DIEGO TORRE SAN FRANCISCO SUITE 206
SAN JUAN PR
00923-3003
US

IV. Provider business mailing address

59 CALLE JAGUAS MILAVILLE
SAN JUAN PR
00926-5119
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-5100
  • Fax: 787-764-2472
Mailing address:
  • Phone: 787-672-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number16306
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: