Provider Demographics
NPI:1154499853
Name:CHOCA, PEDRO RAMON (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:RAMON
Last Name:CHOCA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:623-434-6200
Mailing Address - Fax:623-780-3752
Practice Address - Street 1:4131 N 24TH ST
Practice Address - Street 2:STE. B102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6262
Practice Address - Country:US
Practice Address - Phone:602-955-6632
Practice Address - Fax:602-381-1341
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-0638101YA0400X
AZ847103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
763290OtherAETNA BEHAVIORAL HEALTH
AZAZ0616080OtherBLUE CROSS BLUE SHIELD AZ
068297000OtherMAGELLAN BEHAVIORAL HEALT