Provider Demographics
NPI:1902846496
Name:DAVILA MARTINEZ, GLADIMIRO (MD)
Entity Type:Individual
Prefix:DR
First Name:GLADIMIRO
Middle Name:
Last Name:DAVILA MARTINEZ
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:P.O. BOX 1043
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1043
Mailing Address - Country:US
Mailing Address - Phone:787-733-5588
Mailing Address - Fax:787-733-5588
Practice Address - Street 1:CALLE JOSE C. BARBOSA
Practice Address - Street 2:# 68
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-5588
Practice Address - Fax:787-733-5588
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR70782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028612OtherPTAN MEDICARE
PR0085466AOtherHATO TEJAS, PSC , PTAN
PRC79765ZOtherIMAGING & RADIOLOGY ADVOCTES, PSC, PTAN
PR0028612 AOtherMEDICARE PTAN
PR7078OtherPUERTO RICO MEDICINE DOCTOR LICENCE
PR7078OtherPUERTO RICO LICENCE
PRDM-06294-3OtherAMSSCA
PRDM-06294-3OtherAMSSCA
PRC79765ZOtherIMAGING & RADIOLOGY ADVOCTES, PSC, PTAN