Provider Demographics
NPI:1477713303
Name:DAVILA-RIVERA, ALFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:
Last Name:DAVILA-RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 LITTLE RD
Mailing Address - Street 2:# 162
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1864
Mailing Address - Country:US
Mailing Address - Phone:727-345-9615
Mailing Address - Fax:
Practice Address - Street 1:3152 LITTLE RD
Practice Address - Street 2:# 162
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1864
Practice Address - Country:US
Practice Address - Phone:727-345-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121326208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation