Provider Demographics
NPI:1649354994
Name:ECHEANDIA, JUAN CECILIO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CECILIO
Last Name:ECHEANDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:ECHEANDIA
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 3173
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:787-797-7794
Mailing Address - Fax:787-797-7794
Practice Address - Street 1:AVENIDAD PRINCIPAL TOA ALTA HEIGHT N-13
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-797-7794
Practice Address - Fax:787-797-7794
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8230208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7190010OtherHUMANA
PR300005OtherMEDICARE MUCHO MAS
PR80007OtherTRIPLE S
PR065166OtherCRUZ AZUL
E-67675Medicare UPIN
PR0080007Medicare ID - Type UnspecifiedMEDICARE
PR80007OtherTRIPLE S