Provider Demographics
NPI:1578154217
Name:PAULA ECHAZABAL, IDALMIS
Entity Type:Individual
Prefix:
First Name:IDALMIS
Middle Name:
Last Name:PAULA ECHAZABAL
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 1:4722 RIDGE POINT DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-6324
Mailing Address - Country:US
Mailing Address - Phone:786-342-5957
Mailing Address - Fax:
Practice Address - Street 1:2706 W SAINT ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6382
Practice Address - Country:US
Practice Address - Phone:813-999-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-142509OtherRBT