Provider Demographics
NPI:1992127377
Name:ECHEVERRY, OCTAVIO ANDRES
Entity type:Individual
Prefix:MR
First Name:OCTAVIO
Middle Name:ANDRES
Last Name:ECHEVERRY
Suffix:
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 1:3980 PASEO DEL MAR DR
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7483
Mailing Address - Country:US
Mailing Address - Phone:909-994-4955
Mailing Address - Fax:951-940-6021
Practice Address - Street 1:3980 PASEO DEL MAR DR
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7483
Practice Address - Country:US
Practice Address - Phone:909-994-4955
Practice Address - Fax:951-940-6021
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver