Healthcare Provider Details

I. General information

NPI: 1578184396
Provider Name (Legal Business Name): JOSHUA DE VERA ECHEVERRIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 10/29/2022
Certification Date: 10/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 BUHNE ST
EUREKA CA
95501-3238
US

IV. Provider business mailing address

14960 LOS ROBLES AVE
HACIENDA HEIGHTS CA
91745-2616
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPTL2465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: