Provider Demographics
NPI:1619206067
Name:GOCHANGCO, JOHN E (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:GOCHANGCO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 JADE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3956
Mailing Address - Country:US
Mailing Address - Phone:831-475-4024
Mailing Address - Fax:831-475-4344
Practice Address - Street 1:4140 JADE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3956
Practice Address - Country:US
Practice Address - Phone:831-475-4024
Practice Address - Fax:831-475-4344
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20688363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical