Provider Demographics
NPI:1760042766
Name:RIVERA DAVILA, LAURA C (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:RIVERA DAVILA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 AVE ARTERIAL B APT 1208
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2215
Mailing Address - Country:US
Mailing Address - Phone:787-205-4644
Mailing Address - Fax:
Practice Address - Street 1:400 AVE DOMENECH, SUITE 413
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3710
Practice Address - Country:US
Practice Address - Phone:787-753-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22309208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics