Individual
MRS. WANDA IVELISSE DAVILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
ASSMCA CENTRO DE SERVICIO, CARR.13 BARRIO MACHUELO TERRENO HOSPITAL SAN LUCAS, PONCE, PR 00731
(787) 844-0101
Mailing address
URB. VIVES CALLE C #144, GUAYAMA, PR 00784
(787) 214-0413
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
80478
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2629570
RN
PR
01
—
80478
RN
PR
Enumeration date
06/28/2017
Last updated
06/28/2017
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