Provider Demographics
NPI:1225370653
Name:ACEVEDO-ECHEVARRIA, FIDEL A (MD)
Entity Type:Individual
Prefix:
First Name:FIDEL
Middle Name:A
Last Name:ACEVEDO-ECHEVARRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14625 S MOUNTAIN PKWY APT 1060
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7146
Mailing Address - Country:US
Mailing Address - Phone:787-567-9567
Mailing Address - Fax:
Practice Address - Street 1:428 S GILBERT RD STE 115
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2262
Practice Address - Country:US
Practice Address - Phone:480-507-2961
Practice Address - Fax:480-507-2971
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ53429207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program