Provider Demographics
NPI:1235141490
Name:ECHEVERRIA, DOUGLAS HUMBERTO
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:HUMBERTO
Last Name:ECHEVERRIA
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 1:12800 GARDEN GROVE BLVD
Mailing Address - Street 2:F
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2008
Mailing Address - Country:US
Mailing Address - Phone:714-780-0750
Mailing Address - Fax:
Practice Address - Street 1:12800 GARDEN GROVE BLVD
Practice Address - Street 2:F
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2008
Practice Address - Country:US
Practice Address - Phone:714-780-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health