Provider Demographics
NPI:1437408978
Name:SOBERAL, WILMADEL (SW)
Entity Type:Individual
Prefix:MRS
First Name:WILMADEL
Middle Name:
Last Name:SOBERAL
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1450
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-3244
Mailing Address - Country:US
Mailing Address - Phone:787-312-2562
Mailing Address - Fax:787-846-7410
Practice Address - Street 1:CARRETERA #2 CRUCE DAVILA
Practice Address - Street 2:HOSPITAL ATLANTIC MEDICAL CENTER
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-3244
Practice Address - Country:US
Practice Address - Phone:787-312-2562
Practice Address - Fax:787-846-7410
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8873104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker