Provider Demographics
NPI:1407976038
Name:DAVILA, KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MD
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 2188
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-4188
Mailing Address - Country:US
Mailing Address - Phone:787-803-0343
Mailing Address - Fax:787-803-0343
Practice Address - Street 1:129 CALLE JOSE I QUINTON
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3049
Practice Address - Country:US
Practice Address - Phone:787-803-0343
Practice Address - Fax:787-803-0343
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11120207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11120OtherANATHOMIC & CLINICAL PATHOLOGY