Provider Demographics
NPI:1639146202
Name:DAVILA APONTE, WANDA
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:
Last Name:DAVILA APONTE
Suffix:
Gender:F
Credentials:
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 6181
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5181
Mailing Address - Country:US
Mailing Address - Phone:787-780-1445
Mailing Address - Fax:
Practice Address - Street 1:51 CALLE DR VEVE
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6362
Practice Address - Country:US
Practice Address - Phone:787-780-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11957208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice