Provider Demographics
NPI:1376501676
Name:KOCICA, DEIRDRE CHU (AP)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:CHU
Last Name:KOCICA
Suffix:
Gender:F
Credentials:AP
Other - Prefix:MS
Other - First Name:DASHI
Other - Middle Name:CHU
Other - Last Name:KOCICA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AP
Mailing Address - Street 1:430 S DIXIE HWY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2273
Mailing Address - Country:US
Mailing Address - Phone:305-666-2243
Mailing Address - Fax:305-666-9943
Practice Address - Street 1:430 S DIXIE HWY
Practice Address - Street 2:SUITE 211
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2273
Practice Address - Country:US
Practice Address - Phone:305-666-2243
Practice Address - Fax:305-666-9943
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 494171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCO220OtherBLUE CROSS BLUE SHIELD