Provider Demographics
NPI:1306412762
Name:DAVILA RIVERA, JUAN ALEXANDER
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ALEXANDER
Last Name:DAVILA RIVERA
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 1697
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-1697
Mailing Address - Country:US
Mailing Address - Phone:787-360-6070
Mailing Address - Fax:
Practice Address - Street 1:BRONXCARE HEALTH SYSTEMS, DEPT OF DENTISTRY
Practice Address - Street 2:1775 GRAND CONCOURSE 6TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-901-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program