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General NPI Number Information
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NPI Number | 1033246186
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Entity Type | Individual
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Provider Name | MARIO RAFAEL DAVILA M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 16 CALLE GANDARA
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City | COROZAL
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State | PR
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Zip | 00783-1983
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Country | US
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Telephone | 787-859-1059
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Fax | 787-859-1059
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Provider Business Mailing Address
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Address Line | PO BOX 6797 LOIZA STATION
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City | SAN JUAN
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State | PR
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Zip | 00914-6797
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Country | US
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Telephone | 787-859-1059
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Fax | 787-859-1059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 8249
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License Number State | PR
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