Provider Demographics
NPI:1164556361
Name:OLIVO ECHAVARRY, VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:OLIVO ECHAVARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TORRE DE AUXILIO 735 PONCE DE LEON
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5024
Mailing Address - Country:US
Mailing Address - Phone:787-767-0655
Mailing Address - Fax:787-767-0655
Practice Address - Street 1:TORRE DE AUXILIO MUTUO 735 PONCE DE LEON
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5024
Practice Address - Country:US
Practice Address - Phone:787-767-0655
Practice Address - Fax:787-767-0655
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10960207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83300OtherTRIPLE S
PR069980OtherCRUZ AZUL
PR8000673OtherHUMANA
PR8473OtherIMC
PR0083300Medicare ID - Type Unspecified
PR8473OtherIMC