Provider Demographics
NPI:1467032094
Name:GARCIA ECHEMENDIA, OLEIVYS
Entity Type:Individual
Prefix:
First Name:OLEIVYS
Middle Name:
Last Name:GARCIA ECHEMENDIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 W 44TH PL APT 345
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3386
Mailing Address - Country:US
Mailing Address - Phone:305-490-3168
Mailing Address - Fax:
Practice Address - Street 1:1355 W 44TH PL APT 345
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3386
Practice Address - Country:US
Practice Address - Phone:305-490-3168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty