Healthcare Provider Details

I. General information

NPI: 1588740542
Provider Name (Legal Business Name): DR. IGNACIO ECHENIQUE IV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL AUXILIO MUTUO 1200 AVE PONCE DE LEON
SAN JUAN PR
00907-3918
US

IV. Provider business mailing address

534 CALLE TINTILLO URB TINTILLO HLS
GUAYNABO PR
00966-1667
US

V. Phone/Fax

Practice location:
  • Phone: 787-296-0949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number7477
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: