Provider Demographics
NPI:1346239266
Name:WILSON, GILDA M (MT)
Entity Type:Individual
Prefix:MRS
First Name:GILDA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MAYOR ST
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3726
Mailing Address - Country:US
Mailing Address - Phone:787-842-0112
Mailing Address - Fax:787-842-0112
Practice Address - Street 1:31 MAYOR ST
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3726
Practice Address - Country:US
Practice Address - Phone:787-842-0112
Practice Address - Fax:787-842-0112
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0012246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist