Provider Demographics
NPI:1013628213
Name:ECHEVERRI AGUILERA, LEONEL (SA-C)
Entity Type:Individual
Prefix:
First Name:LEONEL
Middle Name:
Last Name:ECHEVERRI AGUILERA
Suffix:
Gender:M
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 1:305 3RD ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3438
Mailing Address - Country:US
Mailing Address - Phone:786-747-1330
Mailing Address - Fax:
Practice Address - Street 1:401 SW 42ND AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1938
Practice Address - Country:US
Practice Address - Phone:786-747-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22774246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty