Provider Demographics
NPI:1588740542
Name:ECHENIQUE, IGNACIO IV
Entity type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:
Last Name:ECHENIQUE
Suffix:IV
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 1:534 CALLE TINTILLO
Mailing Address - Street 2:URB TINTILLO HLS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL AUXILIO MUTUO
Practice Address - Street 2:1200 AVE PONCE DE LEON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3918
Practice Address - Country:US
Practice Address - Phone:787-296-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7477208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29489Medicare ID - Type UnspecifiedPROVIDER'S NUMBER