Provider Demographics
NPI:1225152499
Name:VILA OLIVIERI, MAYRA MILAGROS (BSN)
Entity Type:Individual
Prefix:MISS
First Name:MAYRA
Middle Name:MILAGROS
Last Name:VILA OLIVIERI
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POBOX 1144
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00766
Mailing Address - Country:UM
Mailing Address - Phone:787-847-8113
Mailing Address - Fax:
Practice Address - Street 1:CENTRO PEDIATRICO
Practice Address - Street 2:917 TITO CASTRO AVE
Practice Address - City:PONCE
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00731
Practice Address - Country:UM
Practice Address - Phone:787-842-5884
Practice Address - Fax:787-842-5802
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse