MEDICARE: JESUS RAMIRO DAVILA-ROSA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	863-PA	PR
2	363AM0700X	Medical Physician Assistant	PACN13	FL

General Provider Information

NPI Number	:	1225631203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS RAMIRO DAVILA-ROSA PA

Provider Business Mailing Address
First Line	:	2040 RIVERVIEW ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2657
Country	:	US
Telephone Number	:	904-224-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 RIVERVIEW ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2657
Country	:	US
Telephone Number	:	904-224-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	03/21/2025

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