Provider Demographics
NPI:1407278450
Name:DAVILA RODRIGUEZ, TAINARI (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAINARI
Middle Name:
Last Name:DAVILA RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
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 8129
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:787-798-4592
Mailing Address - Fax:787-798-8236
Practice Address - Street 1:EDIF MEDICO SANTA CRUZ 73 OFIC 212
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-798-4592
Practice Address - Fax:787-798-8236
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5432103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical