Provider Demographics
NPI:1780687947
Name:BELTRAN VIRELLA, WANDA MIGDALIA (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:MIGDALIA
Last Name:BELTRAN VIRELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 364867
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4867
Mailing Address - Country:US
Mailing Address - Phone:787-787-0310
Mailing Address - Fax:787-798-1275
Practice Address - Street 1:SUITE 402 BAYAMON MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-859-4455
Practice Address - Fax:787-859-4454
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29444Medicare ID - Type UnspecifiedPROVIDER NUMBER