Provider Demographics
NPI:1780682385
Name:ECHEVARRIA, ILEANA (MD)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:ECHEVARRIA
Suffix:
Gender:F
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:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0999
Mailing Address - Country:US
Mailing Address - Phone:787-836-3409
Mailing Address - Fax:
Practice Address - Street 1:JOSE VICENTE RODRIGUEZ STREET #609
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-0999
Practice Address - Country:US
Practice Address - Phone:787-836-3409
Practice Address - Fax:787-836-2176
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15413208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-2785Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRI-20628Medicare UPIN