Provider Demographics
NPI:1811363583
Name:AURELIO ETCHEVERRY D O P C
Entity Type:Organization
Organization Name:AURELIO ETCHEVERRY D O P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETCHEVERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-242-7060
Mailing Address - Street 1:1190 BOOKCLIFF AVE #104
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501
Mailing Address - Country:US
Mailing Address - Phone:970-242-7060
Mailing Address - Fax:970-242-6198
Practice Address - Street 1:1190 BOOKCLIFF AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8159
Practice Address - Country:US
Practice Address - Phone:970-242-7060
Practice Address - Fax:970-242-6198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty