Provider Demographics
NPI:1649527961
Name:DAVILA, ROSALIE
Entity type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 115TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2210
Mailing Address - Country:US
Mailing Address - Phone:646-672-5200
Mailing Address - Fax:212-987-1699
Practice Address - Street 1:333 E 115TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2210
Practice Address - Country:US
Practice Address - Phone:646-672-5200
Practice Address - Fax:212-987-1699
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator