Healthcare Provider Details

I. General information

NPI: 1770784662
Provider Name (Legal Business Name): ANNETTE T. ECHEVARRIA OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNETTE T. ECHEVARRIA OTA

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR174 URB.BRISAS DE PALMASOLA CALLE 5 CASA G-9
AGUAS BUENAS PR
00703
US

IV. Provider business mailing address

CARR174 URB.BRISAS DE PALMASOLA CALLE 5 CASA G-9 HC-03 BOX 16080
AGUAS BUENAS PR
00703
US

V. Phone/Fax

Practice location:
  • Phone: 787-299-9648
  • Fax:
Mailing address:
  • Phone: 787-299-9648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberOTA 662
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: