Provider Demographics
NPI:1164516720
Name:ECHAVARRIA, DAVID O (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:O
Last Name:ECHAVARRIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 KANE CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1938
Mailing Address - Country:US
Mailing Address - Phone:305-826-2754
Mailing Address - Fax:
Practice Address - Street 1:1790 W 49TH ST.
Practice Address - Street 2:SUITE 206
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-826-2754
Practice Address - Fax:305-861-4405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3493103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75904Medicare ID - Type UnspecifiedMEDICARE