Provider Demographics
NPI:1902010531
Name:ENRIQUE DAVILA, P.A.
Entity Type:Organization
Organization Name:ENRIQUE DAVILA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-726-0035
Mailing Address - Street 1:1959 SECOFFEE ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3210
Mailing Address - Country:US
Mailing Address - Phone:954-726-0035
Mailing Address - Fax:954-726-4774
Practice Address - Street 1:7431 N UNIVERSITY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2956
Practice Address - Country:US
Practice Address - Phone:954-726-0035
Practice Address - Fax:954-726-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31035174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0278Medicare PIN
FLD63704Medicare UPIN