Provider Demographics
NPI:1063987980
Name:GARCIA ECHAVARRIA, ORTELIO
Entity type:Individual
Prefix:
First Name:ORTELIO
Middle Name:
Last Name:GARCIA ECHAVARRIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 SW 62ND ST APT 212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2005
Mailing Address - Country:US
Mailing Address - Phone:305-316-3731
Mailing Address - Fax:
Practice Address - Street 1:4005 NW 114TH AVE UNIT 4-5
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4374
Practice Address - Country:US
Practice Address - Phone:305-591-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-07
Last Update Date:2018-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9411559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily