Provider Demographics
NPI:1912667106
Name:DAVILA, MELISSA (NL)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:NL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 39 UU 1
Mailing Address - Street 2:PMB 288 SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-475-5499
Mailing Address - Fax:
Practice Address - Street 1:CARR. 174 KM 5.7 BO. GUARAGUAO
Practice Address - Street 2:CHEZ MINI MALL LOCAL 4
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-0095
Practice Address - Country:US
Practice Address - Phone:787-475-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR163175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath