MEDICARE: CARMEN M DAVILA

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	172A00000X	Driver	D140113729510	FL

General Provider Information

NPI Number	:	1912416983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN M DAVILA

Provider Business Mailing Address
First Line	:	5606 LOUIS XIV CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-5829
Country	:	US
Telephone Number	:	813-679-7234
Fax Number	:

Provider Business Practice Location Address
First Line	:	5606 LOUIS XIV CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-5829
Country	:	US
Telephone Number	:	813-679-7234
Fax Number	:

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

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	07/21/2022

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Directions to “ CARMEN M DAVILA ” Practice Location

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