Provider Demographics
NPI:1629121777
Name:WYLY, JULIA R
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:R
Last Name:WYLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22106
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-2106
Mailing Address - Country:US
Mailing Address - Phone:661-665-9087
Mailing Address - Fax:661-665-1487
Practice Address - Street 1:9622 OLDBURY CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1864
Practice Address - Country:US
Practice Address - Phone:661-665-9087
Practice Address - Fax:661-665-1487
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00018542227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified