Healthcare Provider Details

I. General information

NPI: 1629121777
Provider Name (Legal Business Name): MRS. JULIA R WYLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9622 OLDBURY CT
BAKERSFIELD CA
93311-1864
US

IV. Provider business mailing address

PO BOX 22106
BAKERSFIELD CA
93390-2106
US

V. Phone/Fax

Practice location:
  • Phone: 661-665-9087
  • Fax: 661-665-1487
Mailing address:
  • Phone: 661-665-9087
  • Fax: 661-665-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number00018542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: