Provider Demographics
NPI:1184851370
Name:DAVILA, RAFAEL ANGEL III (EDD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ANGEL
Last Name:DAVILA
Suffix:III
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 BRIDGEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6178
Mailing Address - Country:US
Mailing Address - Phone:407-282-5521
Mailing Address - Fax:
Practice Address - Street 1:1024 BRIDGEWAY BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6178
Practice Address - Country:US
Practice Address - Phone:407-282-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL744979101YS0200X
FL43095101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor