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General NPI Number Information
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NPI Number | 1811363583
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Entity Type | Organization
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Legal Business Name | AURELIO ETCHEVERRY D O P C
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 04/03/2023
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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 #104
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City | GRAND JUNCTION
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State | CO
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Zip | 81501
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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 | BUSINESS ADMINISTRATOR
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Name | MRS. LIZETTE ETCHEVERRY
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Credential |
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Telephone | 970-242-7060
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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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