Provider Demographics
NPI:1518035435
Name:DAVILA GONZALEZ, LUIS I (MD)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:I
Last Name:DAVILA GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0840
Mailing Address - Country:US
Mailing Address - Phone:787-859-1520
Mailing Address - Fax:787-693-2000
Practice Address - Street 1:CARRETERA 159 KM 150 B0 PUEBLO
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-0840
Practice Address - Country:US
Practice Address - Phone:787-859-1520
Practice Address - Fax:787-859-1520
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5597208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79669Medicare UPIN
27495Medicare ID - Type Unspecified