Provider Demographics
NPI:1164723615
Name:ECHEVESTRE, LACRISTA JOI (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LACRISTA
Middle Name:JOI
Last Name:ECHEVESTRE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:LACRISTA
Other - Middle Name:JOI
Other - Last Name:FUQUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4638 PARK BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-8601
Mailing Address - Country:US
Mailing Address - Phone:661-644-5281
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLAZA, UCLA DEPT OF ANESTHESIOLOGY
Practice Address - Street 2:SUITE 3325
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7403
Practice Address - Country:US
Practice Address - Phone:310-267-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-14
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY587733163W00000X
CA708406163W00000X
CA4008367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse