Basic Information
| Provider Information | |||||||||
| NPI: | 1144694654 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JODY ECHEGARAY, PSY.D. INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8870 HARGIS ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900342444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242268020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1081 WESTWOOD BLVD STE 221 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900242925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242268020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2015 | ||||||||
| LastUpdateDate: | 11/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | ECHEGARAY | ||||||||
| AuthorizedOfficialFirstName: | JULIO | ||||||||
| AuthorizedOfficialMiddleName: | (JODY) | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4242268020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY27829 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.