Provider Demographics
NPI:1740088350
Name:CHIHUAHUA, BIANCA (PA-C)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:CHIHUAHUA
Suffix:
Gender:
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 1:4670 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1360
Mailing Address - Country:US
Mailing Address - Phone:323-562-3135
Mailing Address - Fax:323-375-0771
Practice Address - Street 1:4670 GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-1360
Practice Address - Country:US
Practice Address - Phone:323-562-3135
Practice Address - Fax:323-375-0771
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA66011363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical