Provider Demographics
NPI:1851499958
Name:DAVILA-SANTINI, LUIS RAPHAEL (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:RAPHAEL
Last Name:DAVILA-SANTINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8420
Mailing Address - Country:US
Mailing Address - Phone:631-591-7460
Mailing Address - Fax:631-591-7461
Practice Address - Street 1:270 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8420
Practice Address - Country:US
Practice Address - Phone:631-591-7460
Practice Address - Fax:631-591-7461
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240620-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY645H6EZ521Medicare UPIN