Provider Demographics
NPI:1720211311
Name:ECHEVERRIA, GAIL LYNN (, PHD, CADC II)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LYNN
Last Name:ECHEVERRIA
Suffix:
Gender:F
Credentials:, PHD, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30955 DE PORTOLA RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2764
Mailing Address - Country:US
Mailing Address - Phone:951-587-0991
Mailing Address - Fax:
Practice Address - Street 1:73255 EL PASEO
Practice Address - Street 2:SUITE 16
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4276
Practice Address - Country:US
Practice Address - Phone:760-776-4665
Practice Address - Fax:760-776-4652
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3742197171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator