Provider Demographics
NPI:1740643873
Name:DAVILA, MILAGROS (MS, ED)
Entity type:Individual
Prefix:
First Name:MILAGROS
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 POLARIS CV
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5920
Mailing Address - Country:US
Mailing Address - Phone:561-601-7905
Mailing Address - Fax:
Practice Address - Street 1:5025 POLARIS CV
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-5920
Practice Address - Country:US
Practice Address - Phone:561-601-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000000000Medicaid