Provider Demographics
NPI:1689316242
Name:DAVILA ALVAREZ, EDDY
Entity Type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:DAVILA ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 NW 17TH CT APT 26
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5474
Mailing Address - Country:US
Mailing Address - Phone:571-365-1058
Mailing Address - Fax:
Practice Address - Street 1:26 NW 17TH CT APT 26
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5474
Practice Address - Country:US
Practice Address - Phone:571-365-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22-171246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant