=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235952193
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AEF PRIMARY CARE CSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2024
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | GOLDEN PLAZA SUITE #3 CARRETERA 402 KM 2.1 BARRIO MARIAS
-----------------------------------------------------
City | ANASCO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-319-5343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 297
-----------------------------------------------------
City | ANASCO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00610-0297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-319-5343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ADALBERTO ECHEVARRIA FELICIANO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 939-319-5343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------