Healthcare Provider Details

I. General information

NPI: 1740376607
Provider Name (Legal Business Name): MICHAEL ECHAVEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUTTER ST SUITE 430
SAN FRANCISCO CA
94102-1107
US

IV. Provider business mailing address

500 SUTTER ST SUITE 430
SAN FRANCISCO CA
94102-1107
US

V. Phone/Fax

Practice location:
  • Phone: 415-392-9800
  • Fax: 415-392-9079
Mailing address:
  • Phone: 415-392-9800
  • Fax: 415-392-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberG062221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: