Healthcare Provider Details

I. General information

NPI: 1750245387
Provider Name (Legal Business Name): ANGIE ELIZABETH CHICAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S B ST
LOMPOC CA
93436-6933
US

IV. Provider business mailing address

101 S B ST
LOMPOC CA
93436-6933
US

V. Phone/Fax

Practice location:
  • Phone: 805-450-9885
  • Fax:
Mailing address:
  • Phone: 805-450-9885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: