Provider Demographics
NPI:1659779486
Name:MABEL Z ECHEANDIA
Entity Type:Organization
Organization Name:MABEL Z ECHEANDIA
Other - Org Name:MABEL ECHEANDIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SADITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-890-8004
Mailing Address - Street 1:3333 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2758
Mailing Address - Country:US
Mailing Address - Phone:813-930-6066
Mailing Address - Fax:813-930-2053
Practice Address - Street 1:3333 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2758
Practice Address - Country:US
Practice Address - Phone:813-960-6066
Practice Address - Fax:813-930-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005SJOtherFLORIDA BLUE