Provider Demographics
NPI:1891284592
Name:AMADO ECHENIQUE, MARIA ELENA (SA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:AMADO ECHENIQUE
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 NW 36TH ST APT 4226
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3482
Mailing Address - Country:US
Mailing Address - Phone:786-920-4004
Mailing Address - Fax:
Practice Address - Street 1:8800 NW 36TH ST APT 4226
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3482
Practice Address - Country:US
Practice Address - Phone:786-920-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-218246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant