Provider Demographics
NPI:1538126289
Name:QUILES, WANDA IVELISSE (MD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:IVELISSE
Last Name:QUILES
Suffix:
Gender:F
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:TORRE SAN CRISTOBAL
Mailing Address - Street 2:SUITE 309
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-813-2089
Mailing Address - Fax:787-840-8821
Practice Address - Street 1:TORRE SAN CRISTOBAL
Practice Address - Street 2:SUITE 309
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-813-2089
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR127452084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRM061418OtherCRUZ AZUL
PR89939OtherSSS