Provider Demographics
NPI:1447345376
Name:ECHEVARRIA RODRIGUEZ, MIGUEL ANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:ECHEVARRIA RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0720
Mailing Address - Country:US
Mailing Address - Phone:787-840-3395
Mailing Address - Fax:787-844-2664
Practice Address - Street 1:1326 SALUD ST
Practice Address - Street 2:EL SENORIAL PLAZA SUITE 105
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1689
Practice Address - Country:US
Practice Address - Phone:787-840-3395
Practice Address - Fax:787-844-2664
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0060472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
04087OtherAMERICAN HEALTH
660396279OtherMAPFRE
PR3002039OtherACAA
0805OtherIMC
600503OtherMMM
7310087OtherHUMANA
029405OtherGLOBAL
660396279OtherPREFERED
27653OtherSSS
051162OtherCA PR
C79685Medicare UPIN
0027653Medicare ID - Type Unspecified