Provider Demographics
NPI:1609972207
Name:CHICKEY, ANNA LOURDES ARMADA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA LOURDES
Middle Name:ARMADA
Last Name:CHICKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 W TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4822
Mailing Address - Country:US
Mailing Address - Phone:213-385-7888
Mailing Address - Fax:213-385-7887
Practice Address - Street 1:2536 W TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4848
Practice Address - Country:US
Practice Address - Phone:213-385-7888
Practice Address - Fax:213-385-7887
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A519920Medicaid
G51014Medicare UPIN
CAW18094Medicare ID - Type Unspecified