Provider Demographics
NPI:1184730376
Name:DAVILA, ANGEL MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:MANUEL
Last Name: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:W5-18 CALLE CERVANTES
Mailing Address - Street 2:HUCARES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6804
Mailing Address - Country:US
Mailing Address - Phone:787-283-2118
Mailing Address - Fax:787-283-2118
Practice Address - Street 1:1462 CALLE PROF AUGUSTO RODRIGUE
Practice Address - Street 2:PAVIA HOSPITAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2145
Practice Address - Country:US
Practice Address - Phone:787-727-0101
Practice Address - Fax:787-728-2641
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10304208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83283Medicare ID - Type Unspecified
PRF52827Medicare UPIN