Healthcare Provider Details

I. General information

NPI: 1699783241
Provider Name (Legal Business Name): JULIO SANGUILY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 METROCENTRE BLVD STE 3
WEST PALM BEACH FL
33407-3100
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 561-594-1840
  • Fax: 800-906-3055
Mailing address:
  • Phone: 772-223-5665
  • Fax: 772-223-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME61666
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: