Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 15588-I | PR |
Y | 208D00000X | General Practice Physician | 22423 | PR |
NPI | 1003328808 |
---|---|
Provider Name | Dr. Rafael A Davila Micheo |
First Address | San Juan, PR 00907-4211 |
Second Address | San Juan, PR 00935-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2017 |
Last Update Date | 17/08/2021 |