Healthcare Provider Details

I. General information

NPI: 1760622211
Provider Name (Legal Business Name): PEDRO AURRECOECHEA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE (M851)
MIAMI FL
33136-1003
US

IV. Provider business mailing address

166 S MELROSE DR
MIAMI SPRINGS FL
33166-5031
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6837
  • Fax: 305-243-8470
Mailing address:
  • Phone: 305-505-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9167674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: