| Doctor Name: | WILDALIS ROVIRA |
| NPI Number: | 1649426255 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 17176 |
| Business Practice Address: | #15 Dr. Basora St. Hospital Perea Mayaguez, PR - 00680 |
| Business Phone Number: | 7878340101 |
| Business Fax Number: | |
| Mailing Address: | Po Box 601, MAYAGUEZ |
| State: | PR |
| Postal Code: | 006810601 |
| Phone Number: | 7874397259 |
| Fax Number: | 7872655951 |
| NPI Enumeration Date: | 08/14/2008 |
| NPI Last Update Date: | 03/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 17176 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |