MEDICARE: PABLO GONZALO ECHEVARRIA VILLANUEVA-MEYER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A173166	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207RN0300X	Nephrology Physician	A173166	CA

General Provider Information

NPI Number	:	1083076814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLO GONZALO ECHEVARRIA VILLANUEVA-MEYER

Provider Business Mailing Address
First Line	:	1505 WILSON TER STE 155
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 WILSON TER STE 155
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4032
Country	:	US
Telephone Number	:	818-500-4055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	07/07/2021

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