Provider Demographics
NPI:1346334182
Name:ETCHEVERRY, AURELIO (DO, PC)
Entity Type:Individual
Prefix:DR
First Name:AURELIO
Middle Name:
Last Name:ETCHEVERRY
Suffix:
Gender:M
Credentials:DO, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 BOOKCLIFF AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8159
Mailing Address - Country:US
Mailing Address - Phone:970-242-7060
Mailing Address - Fax:970-242-6198
Practice Address - Street 1:1190 BOOKCLIFF AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8159
Practice Address - Country:US
Practice Address - Phone:970-242-7060
Practice Address - Fax:970-242-6198
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01317684Medicaid
COF30558Medicare UPIN