ENRIQUE DAVILA MD PA
Osteopathic Medicine at Alton Rd, Miami, FL

License number
Florida ME0031035
Category
Osteopathic Medicine
Type
Hematology & Oncology
Owner
Name: DR. ENRIQUE DAVILA MD
Title: PRESIDENT
Phone: (954) 665-9694
Address
Address
4306 Alton Rd, Miami, FL 33140
National Provider ID: 1609957539
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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ENRIQUE DAVILA, MD, PA

1959 Secoffee St, Miami, FL 33133

Status:
Inactive
Inactive reason:
CANCEL ADM DISS/REV
Registration:
Jul 10, 2006
Inactive since:
May 1, 2009
State ID:
P06000090764
Business type:
Florida Profit Corporation
S:
Enrique Davila (President), 1959 Secoffee St, Miami, FL 33133 (Physical),Luz E Davila, 1959 Secoffee St, Miami, FL 33133 (Physical)
Agent:
Frederick, Michael L, Cpa,75 NE 15 St, Homestead, FL 33030 (Physical)
EIN:
205164611

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