Provider Demographics
NPI:1558909689
Name:ECHEVARRIA, GEORGSHUA LOUIS (PHYD)
Entity Type:Individual
Prefix:
First Name:GEORGSHUA
Middle Name:LOUIS
Last Name:ECHEVARRIA
Suffix:
Gender:M
Credentials:PHYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1280
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-1280
Mailing Address - Country:US
Mailing Address - Phone:787-546-7020
Mailing Address - Fax:
Practice Address - Street 1:479 CALLE ANTOLIN NIN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2863
Practice Address - Country:US
Practice Address - Phone:787-546-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6351103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty