Provider Demographics
NPI:1790082196
Name:DAVILA, CORAL M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CORAL
Middle Name:M
Last Name:DAVILA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CALLE LUIS BARTOLOMEI
Mailing Address - Street 2:URB SAN JOAQUIN
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-2361
Mailing Address - Country:US
Mailing Address - Phone:787-901-8622
Mailing Address - Fax:
Practice Address - Street 1:X1 CALLE 15
Practice Address - Street 2:VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3114
Practice Address - Country:US
Practice Address - Phone:787-901-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical