Provider Demographics
NPI:1427555358
Name:ECHEVARRIA MEDICAL SERVICES
Entity Type:Organization
Organization Name:ECHEVARRIA MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:787-210-8752
Mailing Address - Street 1:625 CALLE PAZ
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9324
Mailing Address - Country:US
Mailing Address - Phone:787-210-8752
Mailing Address - Fax:
Practice Address - Street 1:41 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3122
Practice Address - Country:US
Practice Address - Phone:787-210-8752
Practice Address - Fax:939-697-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15429261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care