Provider Demographics
NPI:1275240822
Name:DAVILA, MALBY MARIA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MALBY
Middle Name:MARIA
Last Name:DAVILA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11612 SW 13TH LN
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4824
Mailing Address - Country:US
Mailing Address - Phone:954-995-1343
Mailing Address - Fax:
Practice Address - Street 1:11612 SW 13TH LN
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4824
Practice Address - Country:US
Practice Address - Phone:954-995-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021806367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty