Provider Demographics
NPI:1174415558
Name:COBAS ECHEMENDIA, GUILLERMO
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:COBAS ECHEMENDIA
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 1:1 NEWPORT AVE APT 609
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2661
Mailing Address - Country:US
Mailing Address - Phone:786-693-3152
Mailing Address - Fax:
Practice Address - Street 1:1 NEWPORT AVE APT 609
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2661
Practice Address - Country:US
Practice Address - Phone:786-693-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV876596163W00000X
FLRN9605951163W00000X
NY847964163W00000X
MARN2388825163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse