Healthcare Provider Details

I. General information

NPI: 1144694654
Provider Name (Legal Business Name): JODY ECHEGARAY, PSY.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 WESTWOOD BLVD STE 221
LOS ANGELES CA
90024-2925
US

IV. Provider business mailing address

8870 HARGIS ST
LOS ANGELES CA
90034-2444
US

V. Phone/Fax

Practice location:
  • Phone: 424-226-8020
  • Fax:
Mailing address:
  • Phone: 424-226-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27829
License Number StateCA

VIII. Authorized Official

Name: DR. JULIO (JODY) ECHEGARAY
Title or Position: CEO
Credential: PSY.D.
Phone: 424-226-8020