Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 17529 | TX |
NPI | 1053317057 |
---|---|
Provider Name | Dr. Elsa A. Echeverri |
First Address | Houston, TX 77055 |
Second Address | Houston, TX 77055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120864701 | (05) | TX |