Provider Demographics
NPI:1326218421
Name:PECACHE, LILLIAN CHI NGUYEN (PA)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:CHI NGUYEN
Last Name:PECACHE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 H ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4301
Mailing Address - Country:US
Mailing Address - Phone:619-409-9999
Mailing Address - Fax:619-409-9905
Practice Address - Street 1:525 H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4301
Practice Address - Country:US
Practice Address - Phone:619-409-9999
Practice Address - Fax:619-409-9905
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA20542363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA117180Medicare PIN