Healthcare Provider Details

I. General information

NPI: 1871918326
Provider Name (Legal Business Name): ILLIANA ERIN ECHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DRIVE BUILDING 2 SUITE 300
AUSTIN TX
78758
US

IV. Provider business mailing address

2200 PARK BEND DRIVE BUILDING 2 SUITE 300
AUSTIN TX
78758
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-5665
  • Fax: 512-997-9092
Mailing address:
  • Phone: 512-836-5665
  • Fax: 512-997-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: