Provider Demographics
NPI:1568237964
Name:VILA TORRES, DERVIS LAURA (ND)
Entity Type:Individual
Prefix:DR
First Name:DERVIS
Middle Name:LAURA
Last Name:VILA TORRES
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0131
Mailing Address - Country:US
Mailing Address - Phone:787-349-9731
Mailing Address - Fax:
Practice Address - Street 1:A6 BLVD. CRISTOBAL COLON
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0072
Practice Address - Country:US
Practice Address - Phone:787-349-9731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000098175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath