Healthcare Provider Details

I. General information

NPI: 1174970685
Provider Name (Legal Business Name): ANGEL ECHEVERRIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 E VINCE ST
VENTURA CA
93001-1737
US

IV. Provider business mailing address

43 E VINCE ST
VENTURA CA
93001-1737
US

V. Phone/Fax

Practice location:
  • Phone: 805-321-0545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: