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Individual

MR. ROBERTO LUIS DAVILA-DEPEDRO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
525 AVE ROOSVELET PLAZA LAS AMERICAS TOWER, SUITE 712, HATO REY, PR 00918-8001
(787) 764-6611
(787) 754-1596
Mailing address
PO BOX 191259, SAN JUAN, PR 00919-1259
(877) 646-6117
(787) 957-3110

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
5154
PR
207ND0101X
MOHS-Micrographic Surgery Physician
5154
PR
207NS0135X
Procedural Dermatology Physician
5154
PR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
27404
MEDICAL CARD SYSTEM
PR
Enumeration date
09/16/2005
Last updated
04/13/2022
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