Provider Demographics
NPI:1558928051
Name:DAVILA PLAZA, GERALDINE R (PA)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:R
Last Name:DAVILA PLAZA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 AVE LAGUNA APT B204
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6405
Mailing Address - Country:US
Mailing Address - Phone:787-461-9058
Mailing Address - Fax:
Practice Address - Street 1:1959 CALLE LOIZA STE 401
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1865
Practice Address - Country:US
Practice Address - Phone:787-630-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical