Provider Demographics
NPI:1669226007
Name:PICHIKA, JAY
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:PICHIKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CALLE DEL JUEGO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2101
Mailing Address - Country:US
Mailing Address - Phone:949-573-3964
Mailing Address - Fax:949-940-8054
Practice Address - Street 1:203 CALLE DEL JUEGO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2101
Practice Address - Country:US
Practice Address - Phone:949-573-3964
Practice Address - Fax:949-940-8054
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3060038933104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness