Provider Demographics
NPI:1679765028
Name:DAVILA, DAFNE E
Entity Type:Individual
Prefix:
First Name:DAFNE
Middle Name:E
Last Name:DAVILA
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:CALLE GALILEO
Mailing Address - Street 2:APTO 8-H
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4513
Mailing Address - Country:US
Mailing Address - Phone:787-764-8952
Mailing Address - Fax:
Practice Address - Street 1:CALLE GALILEO
Practice Address - Street 2:APTO 8-H
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4513
Practice Address - Country:US
Practice Address - Phone:787-764-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR049134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002429OtherLICENSE