Provider Demographics
NPI:1013341718
Name:ESPADA, WIDNA DEL MORAL (TO)
Entity Type:Individual
Prefix:MISS
First Name:WIDNA
Middle Name:DEL MORAL
Last Name:ESPADA
Suffix:
Gender:F
Credentials:TO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VALLE DE LA PROVIDENCIA CALLE 6 H 30
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723
Mailing Address - Country:US
Mailing Address - Phone:787-410-4894
Mailing Address - Fax:
Practice Address - Street 1:URB. VALLE DE LA PROVIDENCIA CALLE 6 H 30
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723
Practice Address - Country:US
Practice Address - Phone:787-410-4894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR864225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics