Provider Demographics
NPI:1710118617
Name:CHOQUETTE, ALICIA GRACE (PA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:GRACE
Last Name:CHOQUETTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:GRACE
Other - Last Name:SON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6010 HIDDEN VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4219
Mailing Address - Country:US
Mailing Address - Phone:760-631-3000
Mailing Address - Fax:760-631-3016
Practice Address - Street 1:6010 HIDDEN VALLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4219
Practice Address - Country:US
Practice Address - Phone:760-631-3000
Practice Address - Fax:760-631-3016
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710118617Medicaid
CA1710118617Medicaid
CA1710118617Medicaid