Organization
JOHN L ETCHEVERRY DPM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN L ETCHEVERRY M.D. (PRESIDENT/OWNER)
(818) 901-6600
Entity
Organization
Contact information
Practice address
2400 BAHAMAS DR, 200, BAKERSFIELD, CA 93309-0745
(661) 328-5565
(818) 997-7826
Mailing address
6815 NOBLE AVE, VAN NUYS, CA 91405-3796
(818) 901-6600
(818) 997-7826
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
E4099
CA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
E4099
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760573745
NPI
CA
01
—
6407390001
PTAN
CA
Enumeration date
05/05/2010
Last updated
06/13/2011
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