Provider Demographics
NPI:1649775743
Name:DAVILA CASTRODAD, ICIAR MARIE
Entity Type:Individual
Prefix:
First Name:ICIAR
Middle Name:MARIE
Last Name:DAVILA CASTRODAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND LA CIMA DE TORRIMAR
Mailing Address - Street 2:14 CARR 833 APT 603
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-219-3400
Mailing Address - Fax:
Practice Address - Street 1:COND LA CIMA DE TORRIMAR
Practice Address - Street 2:14 CARR 833 APT 603
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-219-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program