Healthcare Provider Details

I. General information

NPI: 1053623710
Provider Name (Legal Business Name): MR. JULIO E ECHEGARAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 4TH ST FL 2
SANTA MONICA CA
90401-2332
US

IV. Provider business mailing address

8870 HARGIS ST
LOS ANGELES CA
90034-2444
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-9871
  • Fax: 310-395-0863
Mailing address:
  • Phone: 424-226-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: