Healthcare Provider Details

I. General information

NPI: 1912272741
Provider Name (Legal Business Name): DIGITAL ECHO ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70252 HILLSIDE CT
BRUCE TWP MI
48065-5345
US

IV. Provider business mailing address

70252 HILLSIDE CT
BRUCE TWP MI
48065-5345
US

V. Phone/Fax

Practice location:
  • Phone: 804-986-6744
  • Fax: 757-299-8403
Mailing address:
  • Phone: 804-986-6744
  • Fax: 757-299-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number00039737
License Number StateMI

VIII. Authorized Official

Name: MR. MARVIN ROY HERNANDEZ
Title or Position: PRESIDENT/CEO
Credential: RCS, RCIS
Phone: 804-986-6744