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General NPI Number Information
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NPI Number | 1346334182
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Entity Type | Individual
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Provider Name | AURELIO ETCHEVERRY D.O., P.C.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 1190 BOOKCLIFF AVE UNIT 104
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8159
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Country | US
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Telephone | 970-242-7060
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Fax | 970-242-6198
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Provider Business Mailing Address
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Address Line | 1190 BOOKCLIFF AVE UNIT 104
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8159
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Country | US
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Telephone | 970-242-7060
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Fax | 970-242-6198
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 31768
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License Number State | CO
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