Healthcare Provider Details

I. General information

NPI: 1376501676
Provider Name (Legal Business Name): DEIRDRE CHU KOCICA AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DASHI CHU KOCICA AP

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S DIXIE HWY SUITE 211
CORAL GABLES FL
33146-2273
US

IV. Provider business mailing address

430 S DIXIE HWY SUITE 211
CORAL GABLES FL
33146-2273
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-2243
  • Fax: 305-666-9943
Mailing address:
  • Phone: 305-666-2243
  • Fax: 305-666-9943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: