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General NPI Number Information
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NPI Number | 1902010531
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Entity Type | Organization
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Legal Business Name | ENRIQUE DAVILA, P.A.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 7431 N UNIVERSITY DR SUITE 110
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City | TAMARAC
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State | FL
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Zip | 33321-2956
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Country | US
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Telephone | 954-726-0035
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Fax | 954-726-4774
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Provider Business Mailing Address
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Address Line | 1959 SECOFFEE ST
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City | MIAMI
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State | FL
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Zip | 33133-3210
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Country | US
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Telephone | 954-726-0035
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Fax | 954-726-4774
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Authorized Official
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Title or Position | PRESIDENT
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Name | ENRIQUE DAVILA
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Credential | M.D.
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Telephone | 954-726-0035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME31035
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License Number State | FL
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