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NPI Code Detail

MEDICARE: DR. JOHN LOUIS ETCHEVERRY DPM

MEDICARE: DR. JOHN LOUIS ETCHEVERRY DPM
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
1213ES0103XFoot & Ankle Surgery PodiatristE4099CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00904698OTHERCARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2000E40990OTHERBLUE SHIELD

General Provider Information

NPI Number : 1760573745
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN LOUIS ETCHEVERRY DPM
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5201 TRUXTUN AVE
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-0421
Country : US
Telephone Number : 661-328-5565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 04/21/2025

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