Provider Demographics
NPI:1427106269
Name:DAVILA GONZALEZ, LUIS A
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:DAVILA GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MONTE CLARO PLAZA 37 MQ 16
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-793-8989
Mailing Address - Fax:
Practice Address - Street 1:1028 AVE FD ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2904
Practice Address - Country:US
Practice Address - Phone:787-706-8705
Practice Address - Fax:787-706-9334
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10141208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice