Provider Demographics
NPI:1285367458
Name:CHICCO, VERONICA THERESE (PA)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:THERESE
Last Name:CHICCO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:THERESE
Other - Last Name:RAYGOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 N MACLAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2906
Mailing Address - Country:US
Mailing Address - Phone:818-697-8585
Mailing Address - Fax:
Practice Address - Street 1:107 N MACLAY AVE
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2906
Practice Address - Country:US
Practice Address - Phone:818-697-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1222433363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant