Healthcare Provider Details

I. General information

NPI: 1114620002
Provider Name (Legal Business Name): PANGCHIA THAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PARMAC RD
CHICO CA
95926-2294
US

IV. Provider business mailing address

1520 LOCUST ST APT 2
CHICO CA
95928-6680
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2850
  • Fax:
Mailing address:
  • Phone: 530-353-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number701586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: