Provider Demographics
NPI:1487433397
Name:CHAPA, VIVIANNA JACLYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:VIVIANNA
Middle Name:JACLYNN
Last Name:CHAPA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VIVIANNA
Other - Middle Name:JACLYNN
Other - Last Name:CAVAZOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:1010 S PONDS DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1409
Practice Address - Country:US
Practice Address - Phone:713-442-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant