Provider Demographics
NPI:1841972700
Name:ORTIZ DAVILA, MARLA I (NURSE)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:I
Last Name:ORTIZ DAVILA
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0146
Mailing Address - Country:US
Mailing Address - Phone:939-282-8235
Mailing Address - Fax:
Practice Address - Street 1:VISTAS DEL OCEANO CALLE JAZMIN 8158
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772-0077
Practice Address - Country:US
Practice Address - Phone:939-282-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR76184163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse