MEDICARE: EDDIE ISMAEL ECHEVARRIA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0705X	Medical-Surgical Registered Nurse	030230	PR

General Provider Information

NPI Number	:	1568523256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDDIE ISMAEL ECHEVARRIA RN

Provider Business Mailing Address
First Line	:	URB VEREDAS
Second Line	:	731 VEREDA DE LOS CEDROS
City	:	GURABO
State	:	PR
Zip	:	00778
Country	:	US
Telephone Number	:	787-415-9097
Fax Number	:	787-707-2280

Provider Business Practice Location Address
First Line	:	218 BROOK ST BLDG 21
Second Line	:	RODRIGUEZ ARMY HEALTH CLINIC
City	:	FORT BUCHANAN
State	:	PR
Zip	:	00934-4206
Country	:	US
Telephone Number	:	787-707-2108
Fax Number	:	787-707-2280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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