Provider Demographics
NPI:1144595976
Name:ECHAVARRIA, JESSE JOHN (RRW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:JOHN
Last Name:ECHAVARRIA
Suffix:
Gender:M
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441AUBURN BVLD,
Mailing Address - Street 2:SUITE E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841
Mailing Address - Country:US
Mailing Address - Phone:916-473-5764
Mailing Address - Fax:
Practice Address - Street 1:4441AUBURN BVLD
Practice Address - Street 2:SUITE E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841
Practice Address - Country:US
Practice Address - Phone:916-473-5764
Practice Address - Fax:916-473-5766
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)