Provider Demographics
NPI:1750573408
Name:HERNANDEZ DAVILA, LETICIA (MD)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:HERNANDEZ DAVILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:HERNANDEZ DAVILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 79511
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9511
Mailing Address - Country:US
Mailing Address - Phone:787-657-0091
Mailing Address - Fax:787-657-0091
Practice Address - Street 1:ESCORIAL BUILDING ONE, STE. 240
Practice Address - Street 2:1400 PARQUE SUR AVE.
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-463-0661
Practice Address - Fax:787-757-7821
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17952207R00000X, 208D00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice