Provider Demographics
NPI:1003002288
Name:GICHURU, STEVE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:GICHURU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 OUTRIGGER
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3397
Mailing Address - Country:US
Mailing Address - Phone:562-414-4166
Mailing Address - Fax:
Practice Address - Street 1:409 E MERCED AVE STE A
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-5061
Practice Address - Country:US
Practice Address - Phone:625-931-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15965363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical