Healthcare Provider Details

I. General information

NPI: 1619116480
Provider Name (Legal Business Name): LUZ Y ECHEVERRI M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUZ Y ECHEVERRI M.A

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7489 E STAGE COACH TRL 7489 E STAGE COACH TRAIL
FLORAL CITY FL
34436-3608
US

IV. Provider business mailing address

7489 ESTAGE COACHTRAIL
FLORAL CITY FL
34436
US

V. Phone/Fax

Practice location:
  • Phone: 352-419-4700
  • Fax: 353-419-4700
Mailing address:
  • Phone: 352-419-4700
  • Fax: 352-419-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberM.A 20706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: