Provider Demographics
NPI:1033246186
Name:DAVILA, MARIO RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:RAFAEL
Last Name:DAVILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6797
Mailing Address - Street 2:LOIZA STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-6797
Mailing Address - Country:US
Mailing Address - Phone:787-859-1059
Mailing Address - Fax:787-859-1059
Practice Address - Street 1:16 CALLE GANDARA
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-1983
Practice Address - Country:US
Practice Address - Phone:787-859-1059
Practice Address - Fax:787-859-1059
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2014-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR8249207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82270DAMedicare ID - Type Unspecified
PRE62803Medicare UPIN