Healthcare Provider Details

I. General information

NPI: 1609592336
Provider Name (Legal Business Name): DALVIS JESUS ECHEVARRIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15924 SW 92ND AVE
MIAMI FL
33157-1842
US

IV. Provider business mailing address

4253 NW 5TH ST
MIAMI FL
33126-5457
US

V. Phone/Fax

Practice location:
  • Phone: 305-964-5824
  • Fax: 786-452-1200
Mailing address:
  • Phone: 786-684-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: