Healthcare Provider Details

I. General information

NPI: 1760573745
Provider Name (Legal Business Name): JOHN LOUIS ETCHEVERRY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 TRUXTUN AVE
BAKERSFIELD CA
93309-0421
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-5565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: