Provider Demographics
NPI:1659022135
Name:LOCOCO, CHRISTIAN (PA-S)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:LOCOCO
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 DOE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9395
Mailing Address - Country:US
Mailing Address - Phone:318-465-3373
Mailing Address - Fax:
Practice Address - Street 1:2635 DOE RIDGE DR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-9395
Practice Address - Country:US
Practice Address - Phone:318-465-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant