Provider Demographics
NPI:1699177014
Name:DAVILA MARCANO, KEYLA
Entity Type:Individual
Prefix:DR
First Name:KEYLA
Middle Name:
Last Name:DAVILA MARCANO
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 1:956 CALLE YABOA REAL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3354
Mailing Address - Country:US
Mailing Address - Phone:787-967-9581
Mailing Address - Fax:
Practice Address - Street 1:CALLE HERNANDEZ CARRION
Practice Address - Street 2:MANATI PROFESSIONAL PLAZA SUITE OFFICE 304
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-967-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31266390200000X
TXBP10062689390200000X
PR21558207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10062689OtherPHYSICIAN INTRAING PERMIT