Healthcare Provider Details

I. General information

NPI: 1497007678
Provider Name (Legal Business Name): ANTONIO EZEQUIEL OLAECHEA CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 SW 149TH CT
MIAMI FL
33194-2931
US

IV. Provider business mailing address

906 SW 149TH CT
MIAMI FL
33194-2931
US

V. Phone/Fax

Practice location:
  • Phone: 786-302-8374
  • Fax:
Mailing address:
  • Phone: 786-302-8374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT15304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: