Provider Demographics
NPI:1952515694
Name:JORGE-BARRETO, WANDA ANGELICA (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:ANGELICA
Last Name:JORGE-BARRETO
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 1:54 BOULEVARD DE LA MEDIA LUNA
Mailing Address - Street 2:COND. JARDINES DEL PARQUE APT. 1504
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-4933
Mailing Address - Country:US
Mailing Address - Phone:787-379-5933
Mailing Address - Fax:
Practice Address - Street 1:54 BOULEVARD DE LA MEDIA LUNA
Practice Address - Street 2:COND. JARDINES DEL PARQUE APT. 1504
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-4933
Practice Address - Country:US
Practice Address - Phone:787-757-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9603208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice