Provider Demographics
NPI:1164651121
Name:NINICHUCK, JOSHUA LUCAS (PA-C, MPAP)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:LUCAS
Last Name:NINICHUCK
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Gender:M
Credentials:PA-C, MPAP
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Mailing Address - Street 1:1320 EL CAPITAN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6260
Mailing Address - Country:US
Mailing Address - Phone:925-275-0700
Mailing Address - Fax:925-275-0701
Practice Address - Street 1:1320 EL CAPITAN DR STE 200
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-6260
Practice Address - Country:US
Practice Address - Phone:925-275-0700
Practice Address - Fax:925-275-0701
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2025-02-03
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Provider Licenses
StateLicense IDTaxonomies
CA20358363A00000X
SC363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant