Provider Demographics
NPI:1609836113
Name:VIRELLA-SANTANA, WILMA (MD)
Entity Type:Individual
Prefix:DR
First Name:WILMA
Middle Name:
Last Name:VIRELLA-SANTANA
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:PATOLOGIA RCM
Mailing Address - Street 2:PO BOX 29134
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0134
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:787-754-0710
Practice Address - Street 1:PATOLOGIA RCM EDIF. PRINCIPAL OFIC. 391
Practice Address - Street 2:CENTRO MEDICO DE PUERTO RICO, BO. MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-754-0710
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12527207ZP0102X
PR012527246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82203Medicare UPIN
PR80860Medicare PIN