Provider Demographics
NPI:1013900166
Name:DAVILA PEDIATRICS P.C.
Entity Type:Organization
Organization Name:DAVILA PEDIATRICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:VIRGILIO
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-355-8077
Mailing Address - Street 1:1874 BELTLINE RD SW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-5514
Mailing Address - Country:US
Mailing Address - Phone:256-355-8077
Mailing Address - Fax:256-355-8710
Practice Address - Street 1:1874 BELTLINE RD SW
Practice Address - Street 2:SUITE 110
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5514
Practice Address - Country:US
Practice Address - Phone:256-355-8077
Practice Address - Fax:256-355-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17830208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty