Provider Demographics
NPI:1679854954
Name:DAVILA, KYRMARIE M (MD)
Entity type:Individual
Prefix:
First Name:KYRMARIE
Middle Name:M
Last Name:DAVILA
Suffix:
Gender:F
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 1431
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-1431
Mailing Address - Country:US
Mailing Address - Phone:787-458-5858
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO LA PALMA
Practice Address - Street 2:CALLE PERAL #14 SUITE IC
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00677
Practice Address - Country:US
Practice Address - Phone:787-644-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19912207R00000X, 207RG0300X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine