Provider Demographics
NPI:1710958343
Name:CARRION, WANDA VIOLETA (MD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:VIOLETA
Last Name:CARRION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:64 CALLE SANTA CRUZ
Mailing Address - Street 2:GALERIA MEDICA SUITE208
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7003
Mailing Address - Country:US
Mailing Address - Phone:787-269-1022
Mailing Address - Fax:787-269-1077
Practice Address - Street 1:64 CALLE SANTA CRUZ
Practice Address - Street 2:GALERIA MEDICA SUITE 208
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7003
Practice Address - Country:US
Practice Address - Phone:787-269-1022
Practice Address - Fax:787-269-1077
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11415174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist