Provider Demographics
NPI:1790039766
Name:DAVILA CASTRODAD, NICOLLE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:
Last Name:DAVILA CASTRODAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY PEDIATRIC HOSPITAL
Mailing Address - Street 2:CENTRO MEDICO DE PUERTO RICO, BARRIO MONACILLOS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00935-0001
Mailing Address - Country:US
Mailing Address - Phone:787-474-0333
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL PEDIATRICO
Practice Address - Street 2:CENTRO MEDICO DE PUERTO RICO, BARRIO MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-474-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR019109208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics