Provider Demographics
NPI:1457057440
Name:CONCEPCION ECHEVARRIA, DALYTZIE RAQUEL
Entity Type:Individual
Prefix:
First Name:DALYTZIE
Middle Name:RAQUEL
Last Name:CONCEPCION ECHEVARRIA
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 1:303 W HOBBS ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-1865
Mailing Address - Country:US
Mailing Address - Phone:575-910-7195
Mailing Address - Fax:
Practice Address - Street 1:6548 43RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-1993
Practice Address - Country:US
Practice Address - Phone:806-370-7820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant