MEDICARE: MABEL DAVILA M.D.

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	2084P0800X	Psychiatry Physician	2490	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2409	OTHER	PR	LICENCE

General Provider Information

NPI Number	:	1992823181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MABEL DAVILA M.D.

Provider Business Mailing Address
First Line	:	602 AVE FERNANDEZ JUNCOS
Second Line	:	2603 CARIBBEAN SEA VIEW
City	:	SAN JUAN
State	:	PR
Zip	:	00907-3149
Country	:	US
Telephone Number	:	787-636-2408
Fax Number	:	787-724-6622

Provider Business Practice Location Address
First Line	:	602 AVE FERNANDEZ JUNCOS
Second Line	:	2603 CARIBBEAN SEA VIEW
City	:	SAN JUAN
State	:	PR
Zip	:	00907-3149
Country	:	US
Telephone Number	:	787-636-2408
Fax Number	:	787-724-6622

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	04/12/2026

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