Provider Demographics
NPI:1215178769
Name:CHUJUTALLI, RICARDO (CSA)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:CHUJUTALLI
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Gender:M
Credentials:CSA
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Mailing Address - Street 1:4924 MARSH HARRIER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3057
Mailing Address - Country:US
Mailing Address - Phone:972-652-0705
Mailing Address - Fax:972-752-7889
Practice Address - Street 1:4924 MARSH HARRIER AVE
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3057
Practice Address - Country:US
Practice Address - Phone:972-652-0705
Practice Address - Fax:972-752-7889
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2015-03-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant