Provider Demographics
NPI:1376556506
Name:ECHEVERRI, JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:ECHEVERRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 REMITTANCE DR
Mailing Address - Street 2:DEPT 6008
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6008
Mailing Address - Country:US
Mailing Address - Phone:562-282-1419
Mailing Address - Fax:562-920-4642
Practice Address - Street 1:4476 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6359
Practice Address - Country:US
Practice Address - Phone:323-563-9499
Practice Address - Fax:313-563-0956
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52822207Q00000X
CA52822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080179420OtherMEDICARE RAILROAD
CA00A528220OtherBLUE SHIELD
CA00A528220Medicaid
CA080179420OtherRAILROAD MEDICARE
CA080179420OtherRAILROAD MEDICARE
CA080179420OtherMEDICARE RAILROAD