Provider Demographics
NPI:1740356468
Name:CASIANO QUILES, WANDA (MD)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:CASIANO QUILES
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:PO BOX 5075
Mailing Address - Street 2:PMB 205
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-264-3289
Mailing Address - Fax:787-892-2540
Practice Address - Street 1:CALLE HERNAN ALVAREZ # 206
Practice Address - Street 2:PLAZA METROPOLITANA
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-264-3289
Practice Address - Fax:787-892-2540
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H82123Medicare UPIN
PR89619Medicare ID - Type Unspecified