Provider Demographics
NPI:1881011781
Name:ECHEVARRIA-COLON, MICHELLE I
Entity Type:Individual
Prefix:
First Name:MICHELLE I
Middle Name:
Last Name:ECHEVARRIA-COLON
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 1:10 CALLE CASIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3200
Mailing Address - Country:US
Mailing Address - Phone:787-641-7582
Mailing Address - Fax:787-641-4561
Practice Address - Street 1:16308 E COURSE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1128
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:787-641-4561
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1407582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology