Provider Demographics
NPI:1700153871
Name:UGARTECHEA, MARCO ANTONIO JR
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:ANTONIO
Last Name:UGARTECHEA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14414 SW 109TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6643
Mailing Address - Country:US
Mailing Address - Phone:305-613-2228
Mailing Address - Fax:
Practice Address - Street 1:7715 NW 48TH ST
Practice Address - Street 2:360B
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-5455
Practice Address - Country:US
Practice Address - Phone:305-846-9807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst