Provider Demographics
NPI:1669449187
Name:ECHEVERRIA, CARMELO ALFONZO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMELO
Middle Name:ALFONZO
Last Name:ECHEVERRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 N MASTICK WAY
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1063
Mailing Address - Country:US
Mailing Address - Phone:520-761-2133
Mailing Address - Fax:520-761-2147
Practice Address - Street 1:1852 N MASTICK WAY
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-1063
Practice Address - Country:US
Practice Address - Phone:520-761-2133
Practice Address - Fax:520-281-1112
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29834207QG0300X
AZ34090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ937617Medicaid
AZ105680Medicare ID - Type UnspecifiedMEDICARE #
AZ937617Medicaid