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General NPI Number Information
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NPI Number | 1457800609
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Entity Type | Individual
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Provider Name | MR. RUBEN ECHEVERRIA
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Gender | Male
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 1212 CALIFORNIA ST.
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City | STOCKTON
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State | CA
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Zip | 95204
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Country | US
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Telephone | 209-468-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 2756 DONNER TRL
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City | RIVERBANK
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State | CA
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Zip | 95367-9583
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Country | US
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Telephone | 209-408-3398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | PT 36928
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License Number State | CA
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