Healthcare Provider Details

I. General information

NPI: 1730189606
Provider Name (Legal Business Name): MIGUEL M ECHENIQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON
SAN JUAN PR
00917-5025
US

IV. Provider business mailing address

A30 CALLE 1 URB PARQUES DE SAN IGNACIO
SAN JUAN PR
00921-4839
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-4197
  • Fax: 787-764-1828
Mailing address:
  • Phone: 787-751-4197
  • Fax: 787-764-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6424
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: