Provider Demographics
NPI:1831261031
Name:GIROCCO, SUSANNA L (PA-C)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:L
Last Name:GIROCCO
Suffix:
Gender:F
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:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05092363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191910202Medicaid
TX8Y8344OtherBCBSTX
TX191910205 (MDACC)Medicaid
TX8526NUOtherBCBS (MDACC)
TX8Y1250OtherBCBS
TX454531YKQH (MDACC)Medicare PIN
TX8Y1250OtherBCBS
TXP00631627Medicare PIN
TX8526NUOtherBCBS (MDACC)
Q77135Medicare UPIN
TX191910205 (MDACC)Medicaid