MEDICARE: DAVILA MEDICAL GROUP INC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1649988890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVILA MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	13270 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-1178
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13270 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-1178
Country	:	US
Telephone Number	:	786-631-4972
Fax Number	:	786-633-5130

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIRELYS VALDES ESPINOSA
Credential	:
Telephone Number	:	305-439-4877

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	11/07/2022

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