Provider Demographics
NPI:1174739874
Name:DAVILA, SANDRA IVETTE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:IVETTE
Last Name:DAVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUZON 254 BO. MARIANA
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718
Mailing Address - Country:US
Mailing Address - Phone:787-922-3217
Mailing Address - Fax:
Practice Address - Street 1:HOSP PEDIATRICO DR ANTONIO ORTIZ
Practice Address - Street 2:#52 CENTRO MEDICO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00719-1079
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR573225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant