Healthcare Provider Details

I. General information

NPI: 1619206067
Provider Name (Legal Business Name): JOHN E. GOCHANGCO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 JADE ST SUITE 100
CAPITOLA CA
95010-3956
US

IV. Provider business mailing address

4140 JADE ST SUITE 100
CAPITOLA CA
95010-3956
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-4024
  • Fax: 831-475-4344
Mailing address:
  • Phone: 831-475-4024
  • Fax: 831-475-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA20688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: