Provider Demographics
NPI:1821417718
Name:ECHON, RICARDO (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:ECHON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 W 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376
Mailing Address - Country:US
Mailing Address - Phone:209-832-8984
Mailing Address - Fax:
Practice Address - Street 1:644 W 12TH STREET
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376
Practice Address - Country:US
Practice Address - Phone:209-832-8984
Practice Address - Fax:209-832-8988
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily