Provider Demographics
NPI:1194461616
Name:ECHIPARE, RODOLFO JR
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:ECHIPARE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9642 LADY BIRD CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8311
Mailing Address - Country:US
Mailing Address - Phone:775-560-2205
Mailing Address - Fax:
Practice Address - Street 1:9642 LADY BIRD CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-8311
Practice Address - Country:US
Practice Address - Phone:775-560-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-08
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN685835164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse