Provider Demographics
NPI:1013017508
Name:RIVERA-DAVILA, ALEXIS DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:DAVID
Last Name:RIVERA-DAVILA
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 1:582 CALLE REINITA
Mailing Address - Street 2:MANSIONES DE MONTECASINO II
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-2256
Mailing Address - Country:US
Mailing Address - Phone:787-209-6066
Mailing Address - Fax:787-251-8149
Practice Address - Street 1:GENERAL VALERO AVENUE 410
Practice Address - Street 2:TORRE MEDICA SUITE 202
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-0005
Practice Address - Fax:787-860-0676
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15769282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital