Provider Demographics
NPI:1235234758
Name:DAVILA AGOSTO, EMILIO J
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:J
Last Name:DAVILA AGOSTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0847
Mailing Address - Country:US
Mailing Address - Phone:787-404-0678
Mailing Address - Fax:
Practice Address - Street 1:PR-2, KM 48.2
Practice Address - Street 2:SECTOR LA LOMITA
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-369-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16603208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice