Provider Demographics
NPI:1497007678
Name:OLAECHEA, ANTONIO EZEQUIEL (CRT)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:EZEQUIEL
Last Name:OLAECHEA
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 SW 149TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2931
Mailing Address - Country:US
Mailing Address - Phone:786-302-8374
Mailing Address - Fax:
Practice Address - Street 1:906 SW 149TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2931
Practice Address - Country:US
Practice Address - Phone:786-302-8374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT15304227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified