Provider Demographics
NPI:1407482763
Name:MOLINA DAVILA, LUIS ERNESTO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ERNESTO
Last Name:MOLINA DAVILA
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 1623
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-1623
Mailing Address - Country:US
Mailing Address - Phone:787-955-3400
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 172, CAGUAS, 00726
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-955-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program