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General NPI Number Information
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NPI Number | 1144694654
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Entity Type | Organization
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Legal Business Name | JODY ECHEGARAY, PSY.D. INC.
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 1081 WESTWOOD BLVD STE 221
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City | LOS ANGELES
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State | CA
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Zip | 90024-2925
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Country | US
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Telephone | 424-226-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 8870 HARGIS ST
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City | LOS ANGELES
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State | CA
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Zip | 90034-2444
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Country | US
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Telephone | 424-226-8020
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JULIO (JODY) ECHEGARAY
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Credential | PSY.D.
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Telephone | 424-226-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY27829
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License Number State | CA
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