Healthcare Provider Details

I. General information

NPI: 1659331692
Provider Name (Legal Business Name): JOSE GUILLERMO AMY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MARGINAL E 1
BAYAMON PR
00957-2536
US

IV. Provider business mailing address

CALLE 1 B 14 URB TINTILLO GARDENS
GUAYNABO PR
00966
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-3967
  • Fax: 787-269-5686
Mailing address:
  • Phone: 787-798-3967
  • Fax: 787-269-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number13118
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: