Provider Demographics
NPI:1306303524
Name:ECHAGARRUGA, OTHONIEL
Entity type:Individual
Prefix:
First Name:OTHONIEL
Middle Name:
Last Name:ECHAGARRUGA
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 1:7000 NW 177TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6274
Mailing Address - Country:US
Mailing Address - Phone:786-416-1396
Mailing Address - Fax:
Practice Address - Street 1:7000 NW 177TH ST APT 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6274
Practice Address - Country:US
Practice Address - Phone:786-416-1396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily