Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 021601 | PR |
NPI | 1033755913 |
---|---|
Provider Name | Wilmer Davila |
First Address | Boqueron, PR 00622-9619 |
Second Address | Cabo Rojo, PR 00623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2019 |
Last Update Date | 26/11/2019 |