Provider Demographics
NPI:1942914460
Name:ECHEVARRIA, KEVIN K
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:K
Last Name:ECHEVARRIA
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 1:1110 JARVIS RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-9733
Mailing Address - Country:US
Mailing Address - Phone:856-630-8610
Mailing Address - Fax:
Practice Address - Street 1:1110 JARVIS RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-9733
Practice Address - Country:US
Practice Address - Phone:856-630-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJE13784337212822172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver