Provider Demographics
NPI:1174094239
Name:DYCHIOCO, JADRAN (NP-C)
Entity type:Individual
Prefix:
First Name:JADRAN
Middle Name:
Last Name:DYCHIOCO
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27727 SUMMER GROVE PL
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1895
Mailing Address - Country:US
Mailing Address - Phone:661-513-7332
Mailing Address - Fax:
Practice Address - Street 1:27875 SMYTH DR STE 101
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-6064
Practice Address - Country:US
Practice Address - Phone:661-702-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA773475163WE0003X
CA95010596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency