Provider Demographics
NPI:1063565471
Name:ECHEANDIA, MABEL Z (MD)
Entity type:Individual
Prefix:DR
First Name:MABEL
Middle Name:Z
Last Name:ECHEANDIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12880 US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5801
Mailing Address - Country:US
Mailing Address - Phone:813-492-5732
Mailing Address - Fax:813-715-7261
Practice Address - Street 1:12880 US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5801
Practice Address - Country:US
Practice Address - Phone:813-492-5732
Practice Address - Fax:813-715-7261
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377146600Medicaid
2460787OtherAETNA
26396OtherBLUE CROSS BLUE SHIELD
6046OtherFOUNDATION
4769154007OtherCIGNA
280840OtherAVMED
280840OtherAVMED
6046OtherFOUNDATION