Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 011 | PR |
NPI | 1215034749 |
---|---|
Provider Name | Roberto Davila |
First Address | San Juan, PR 00923-1245 |
Second Address | San Juan, PR 00923-1245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2006 |
Last Update Date | 08/07/2007 |