Healthcare Provider Details

I. General information

NPI: 1780595462
Provider Name (Legal Business Name): WHITNEY OLIVIA WILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: W OLIVIA WILLS

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 191293
SAN JUAN PR
00919-1293
US

IV. Provider business mailing address

PO BOX 191293 INTER METRO STUDENT APARTMENTS
SAN JUAN PR
00919-1293
US

V. Phone/Fax

Practice location:
  • Phone: 786-731-5656
  • Fax:
Mailing address:
  • Phone: 786-731-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: