Provider Demographics
NPI:1588067839
Name:DAVILA, MICHAEL JOSEPH (HAS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:DAVILA
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-286-3186
Practice Address - Street 1:145 MIDDLE STREET, SUITE 1131
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3567
Practice Address - Country:US
Practice Address - Phone:407-804-0333
Practice Address - Fax:407-804-0353
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4408237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist