Provider Demographics
NPI:1275564718
Name:NAVARRO, WILFREDO (MD)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:NAVARRO
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:HC 1 BOX 6527
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-9748
Mailing Address - Country:US
Mailing Address - Phone:939-242-8210
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 6527
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-9748
Practice Address - Country:US
Practice Address - Phone:939-242-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL267732085R0202X
PR0138622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932272Medicaid
AL051529396OtherBLUE CROSS
AL009932273Medicaid
AL051529401OtherBLUE CROSS
AL051529397OtherBLUE CROSS
AL010033CI37054OtherSECTION 1011
ALP00251362OtherRAILROAD MEDICARE
AL009932276Medicaid
AL051529394OtherBLUE CROSS
AL009932274Medicaid
AL009932276Medicaid