Provider Demographics
NPI:1013199900
Name:DAVILA, RUTH (MT)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:LABORATORIO
Other - Middle Name:CLINICO
Other - Last Name:CARIBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:A31 CALLE 1
Mailing Address - Street 2:EXT VILLA RICA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5019
Mailing Address - Country:US
Mailing Address - Phone:787-798-3176
Mailing Address - Fax:787-288-0774
Practice Address - Street 1:1875 CARR 2 STE 103
Practice Address - Street 2:MEDICAL OHTHALMIC PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7218
Practice Address - Country:US
Practice Address - Phone:787-798-3176
Practice Address - Fax:787-288-0774
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1266291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038238OtherPTAN
PR0038238Medicare PIN