Healthcare Provider Details

I. General information

NPI: 1619636982
Provider Name (Legal Business Name): WILSON MARTELL JOVET
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 12/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA JOSE FIDALGO DIAZ 4SS6 VILLA FONTANA
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 94
CAROLINA PR
00986-0094
US

V. Phone/Fax

Practice location:
  • Phone: 787-776-3511
  • Fax: 787-757-2039
Mailing address:
  • Phone: 787-776-3511
  • Fax: 787-757-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: