1720462419 NPI number — DR. ANMARY ALTAGRACIA FERNANDEZ DE CHECO M.D.

Table of content: DR. ANMARY ALTAGRACIA FERNANDEZ DE CHECO M.D. (NPI 1720462419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720462419 NPI number — DR. ANMARY ALTAGRACIA FERNANDEZ DE CHECO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ DE CHECO
Provider First Name:
ANMARY
Provider Middle Name:
ALTAGRACIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERNANDEZ BETANCES
Provider Other First Name:
ANMARY
Provider Other Middle Name:
ALTAGRACIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720462419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4729 N HABANA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33614-7113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-251-8444
Provider Business Mailing Address Fax Number:
813-254-6414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4729 N HABANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33614-7113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-251-8444
Provider Business Practice Location Address Fax Number:
813-254-6414
Provider Enumeration Date:
07/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  ME149758 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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