Healthcare Provider Details

I. General information

NPI: 1144931429
Provider Name (Legal Business Name): JULIO WILFRIDO AMOTT EVALY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CALLE MUNOZ RIVERA W
RINCON PR
00677-2125
US

IV. Provider business mailing address

PO BOX 143
MAYAGUEZ PR
00681-0143
US

V. Phone/Fax

Practice location:
  • Phone: 916-420-0075
  • Fax:
Mailing address:
  • Phone: 916-420-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number023077
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: