Individual
WAGNER GERVAIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
151 CALLE LAS LOMAS, SAN JUAN, PR 00926-5527
(956) 578-6712
Mailing address
151 CALLE LAS LOMAS, SAN JUAN, PR 00926-5527
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
258-PA
PR
Other
Enumeration date
04/05/2020
Last updated
04/05/2020
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