MEDICARE: LAURA ECHEVERRIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1588182000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ECHEVERRIA

Provider Business Mailing Address
First Line	:	3265 26TH ST APT 18
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-4693
Country	:	US
Telephone Number	:	415-583-6197
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 W ORANGE AVE
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-4443
Country	:	US
Telephone Number	:	745-817-7650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	09/29/2017

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Directions to “ LAURA ECHEVERRIA ” Practice Location

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