Provider Demographics
NPI:1518748797
Name:DAVILA SANTANA, SERGIO ANDRES (PHD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:ANDRES
Last Name:DAVILA SANTANA
Suffix:
Gender:M
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:URB. LEVITTOWN
Mailing Address - Street 2:CALLE PASEO AZALEA 2019
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-639-5779
Mailing Address - Fax:
Practice Address - Street 1:URB. LEVITTOWN
Practice Address - Street 2:CALLE PASEO AZALEA 2019
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-639-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical