Provider Demographics
NPI:1356455224
Name:DE FELIX - DAVILA, ROBERTO ANTONIO
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:ANTONIO
Last Name:DE FELIX - DAVILA
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 1:59 CALLE JAGUAS
Mailing Address - Street 2:MILAVILLE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5119
Mailing Address - Country:US
Mailing Address - Phone:787-672-3332
Mailing Address - Fax:
Practice Address - Street 1:369 CALLE DE DIEGO
Practice Address - Street 2:TORRE SAN FRANCISCO SUITE 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3003
Practice Address - Country:US
Practice Address - Phone:787-767-5100
Practice Address - Fax:787-764-2472
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16306208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation