Provider Demographics
NPI:1225077944
Name:RENDON, WILFREDO L (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:L
Last Name:RENDON
Suffix:
Gender:M
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:BOSQUE DEL LAGO
Mailing Address - Street 2:BE-16, VIA ERIE
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-771-7930
Mailing Address - Fax:
Practice Address - Street 1:AVE PONCE DE LEON
Practice Address - Street 2:715, PDA 37
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-771-7930
Practice Address - Fax:787-771-7390
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9173207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81290Medicare ID - Type Unspecified
PRE08538Medicare UPIN