Provider Demographics
NPI:1336735414
Name:ILLICH CAPURRO, JULIO MIGUEL
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:MIGUEL
Last Name:ILLICH CAPURRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 E F ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-1456
Mailing Address - Country:US
Mailing Address - Phone:253-905-1718
Mailing Address - Fax:
Practice Address - Street 1:4312 E F ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-1456
Practice Address - Country:US
Practice Address - Phone:253-905-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC14545171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC14545OtherINTERPRETER